Neuromuscular Disease

Description

The Neuromuscular group specializes in the diagnosis and management of patients with neuromuscular diseases. These include diseases of the anterior horn cell or motor neuron, peripheral nerves, neuromuscular junction and muscle. Specific expertise in our clinic includes the diagnosis and management of patients with diseases of:

  • Peripheral nerves including hereditary neuropathies, acquired demyelinating neuropathies such as the Guillain-Barré syndrome (GBS), multifocal motor neuropathy with conduction block and chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Neuromuscular transmission including myasthenia gravis (MG) and the Lambert Eaton myasthenic syndrome (LEMS)
  • Muscle including the inflammatory myopathies, toxic myopathies and hereditary myopathies including myotonic disorders, channelopathies and muscular dystrophies
  • The Motor Neuron Disease clinic is a separate entity but is closely related to the Neuromuscular Clinic.
Trainees have access to a variety of methods of investigating neuromuscular diseases including electrophysiological testing (EMG and NCS), nerve and muscle biopsies with neuropathological interpretation and genetic testing. Observe outpatient percutaneous core muscle biopsies performed by physicians in the neuromuscular clinic and open muscle and nerve biopsies performed by neurosurgeons.

The neuromuscular group is closely associated with the EMG laboratory at University Campus. The EMG laboratory studies over 3,500 patients a year, including specialized testing for complicated disorders of peripheral nerve, neuromuscular transmission or muscle. ALS researchers, teachers and clinicians are also connected with the neuromuscular group.

Training Opportunities

Residents

During scheduled academic half-days, neurology residents will study neuromuscular diseases including the following sub-topics:

Core Topics

  • Approach to peripheral neuropathy
  • AIDP and CIDP
  • Approach to myopathy
  • Diseases of the neuromuscular junction and their treatment
  • The myotonias
  • IVIg
  • Neuromuscular pearls
  • Clinical examination and investigation for autonomic dysfunction
  • Disorders of the autonomic nervous system
  • Management of respiratory failure in neuromuscular disease
  • Physiological basis of normal EMG/NCS and common EMG/NCS abnormalitites

Special Topics

  • Basic neuroscience
    • Genetics of inherited neuropathies/myopathies
    • Immunopathogenesis of immune-mediated neuropathies
    • Autonomic nervous system
  • Neuropathology: muscle and nerve pathology

PGY4/5 residents also do 2 to 3 months of EMG/ Neuromuscular clinics

Upon graduating, residents will be experts in:

  • Motor Neuron Disease
  • Peripheral Neuropathies
  • Disorders of the nerve root, and brachial and lumbar plexus
  • Neuromuscular Junction Disorders
  • Myopathies and muscle disorders

Learn more about CNS Residency programs.

Autonomic Nerve Fellowship

Main Contact: Kurt Kimpinski - MD, PhD, BSc

phone: 519-663-3337
London Health Sciences Centre
University Hospital, Room C7-131A
339 Windemere Road
London Ontario Canada
N6A 5A5

Fellowship Application Information

Neuromuscular/EMG Fellowship

Main Contact: Christen Shoesmith - MD, FRCPC

phone: 519-663-3597
fax: 519-663-3609
London Health Sciences Centre
University Hospital
339 Windermere Road
London Ontario Canada
N6A 5A5

Fellowship Application Information

Post Doctoral, Graduate and Undergraduate

CNS offers training opportunities for residents in neuromuscular research. Opportunities for MSc, PhD, and Postdoctoral candidates are also available upon request. Dr. Kimpinski has acted as a supervisor and co-supervisor for research associates, PhD candidates, and postdoctoral fellows studying neurogenic orthostatic hypotension complicated by supine hypertension, and the impact of chronic inflammatory demyelinating neuropathy (CIDP) on the neuromuscular system in humans. Dr. Nicolle has acted as a supervisor and c-supervisor to graduate and postdoctoral students studying myasthenia gravis.

CNS offers training opportunities for residents in neurodegeneration research. Opportunities for MSc, PhD, and Postdoctoral candidates are also available upon request. Dr. Shoesmith and Dr. Strong act as supervisors to researchers and fellows conducting research on ALS.

Research Opportunities

If you are interested in conducting cerebrovascular research or are interested in assisting in ongoing research by our faculty, visit their bio pages for information on their specific research interests and how to get in touch.

Recent Neuromuscular Publications

LaDonna KA, Watling CJ, Ray SL, Piechowicz C, Venance SL. Evolving Motivations: Patients' and Caregivers' Perceptions About Seeking Myotonic Dystrophy (DM1) and Huntington's Disease Care. Qual Health Res. 2017 Sep;27(11):1727-1737. doi: 10.1177/1049732317711901. Epub 2017 Jun 19. PubMed PMID: 28799481.

Climans SA, Piechowicz C, Koopman WJ, Venance SL. Survey of Canadian Myotonic Dystrophy Patients' Access to Computer Technology. Can J Neurol Sci. 2017 May 24:1-5. doi: 10.1017/cjn.2017.47. [Epub ahead of print] PMID: 28535832.

Gilmore KJ, Allen MD, Doherty TJ, Kimpinski K, Rice CL. Electrophysiological and neuromuscular stability of persons with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve. 2017 Sep;56(3):413-420. doi: 10.1002/mus.25516. Epub 2017 Mar 23. PMID: 27997686

Takahashi S, Chum M, Kimpinski K. Electrodiagnostic Characterization of Hereditary Neuropathy With Liability to Pressure Palsies. J Clin Neuromuscul Dis. 2017 Mar;18(3):119-124. doi: 10.1097/CND.0000000000000152. PMID: 28221301

Strong MJ, Abrahams S, Goldstein LH, Woolley S, Mclaughlin P, Snowden J, Mioshi E, Roberts-South A, Benatar M, HortobáGyi T, Rosenfeld J, Silani V, Ince PG, Turner MR. Amyotrophic lateral sclerosis - frontotemporal spectrum disorder (ALS-FTSD): Revised diagnostic criteria. Amyotroph Lateral Scler Frontotemporal Degener. 2017 May;18(3-4):153-174. doi: 10.1080/21678421.2016.1267768. Epub 2017 Jan 5. PMID: 28054827

 

Faculty

Neurologists