|
The Neuromuscular Disorders (Muscle Disorders) Fellowship involves
a one-year experience with a research component and an optional
second year in case of outstanding performance and academic promise.
As a Muscle Disorders fellow in the, you will train primarily in
the Muscle Laboratory and see patients in the Neurology Clinic,
which is adjacent to the laboratory.
Clinical Training
Your clinical training will include diagnosis and management
of the entire spectrum of neuromuscular diseases, including:
- Muscle disorders
- Polymyositis
- Dermatomyositis
- Inclusion-body myositis
- Congential myopathy
- Metabolic myopathies
- Mitochondrial myopathy
- Elevated creatine kinase (CK)
- Muscular dystrophies
- Neuromuscular junction disorders
- Myasthenia gravis
- Congenital Myasthenic syndrome
- Lambert-Eaton syndrome
- Botulism
Rotations
During your training, a typical rotation schedule would
be:
- Months 1 and 2: Introduction to enzyme histochemistry
of muscle for routine analysis
- Months 3 and 4: Immunocytochemistry of muscle
for diagnosis and research
- Months 4-6: Introduction to electron microscopy:
theory, practice, elements of fine structure
- Months 7-12: Research project employing one
or more techniques acquired during the first six months
- Months 1-12: Interpretation of muscle biopsies
- Months 1-6: With program director, you will
diagnosis and manage treatment of patients with neuromuscular
diseases
- Months 7-12: Independent diagnosis and management
of patients with neuromuscular diseases
Rotation Descriptions
Enzyme Histochemistry
Enzyme histochemistry has become the gold standard for
evaluating and diagnosing muscle biopsies. However, its usefulness
depends on proper technique. More than 30 histochemical procedures
are used for diagnosis. Of these, 15 are done routinely on every
muscle specimen. You will learn the preparatory technique and learn
to recognize artifacts and pathologic deviations from norm.
Immunocytochemistry
Recently, immunocytochemistry has become increasingly important
in the diagnosis of different muscle diseases. Examples of its use
include immunolocalization of dystrophin, merosin and sarcoglycan
in the muscular dystrophies, immune deposits in myasthenia gravis
and dermatomyositis, immunophenotyping of inflammatory myopathies
and so on.
Introduction to Electron Microscopy
Electron microscopy can elucidate pathologic reactions
that escape detection by light microscopy. Typical examples are
alterations in the neuromuscular junction in myasthenic disorders,
microvascular pathology in dermatomyositis, sarcolemmal defects
in Duchenne dystrophy, Whipple cells in Whipple's disease, or loss
of thick filaments in acute quadriplegic myopathy. You will learn
the electron microscopy technique, become familiar with muscle ultrastructure
and recognize pathological reactions of muscle at the ultrastructural
level.
Research Project
After learning basic laboratory techniques, you will embark
on a research project. You will be encouraged to initiate the planning
of at least one research project and a dialogue prior to the actual
project start. Once the project is underway, you will discuss the
findings and plans with the program director.
Interpretation of Muscle Biopsies
More than 1,400 muscle biopsies are read in Mayo Clinic's
Muscle Laboratory each year. About 220 of these are from Mayo patients;
the remainder comes to Mayo Clinic from other medical centers throughout
the United States for processing and interpretation. A second opinion
or clinical summary accompanies each specimen.
Biopsy reading sessions are held three times per week and provide
an unparalleled opportunity for making clinical-pathological correlations.
Virtually every type of muscle disease is observed during your year
of training. Frequently, a rare or unusual biopsy finding serves
as the basis of a special research project.
A large collection of teaching slides is available for study. The
Muscle Laboratory maintains a library of approximately 8,000 frozen
muscle biopsy specimens stored under liquid nitrogen. This material
is invaluable for special studies on selected diseases.
Diagnosis and Management of Patients
Mayo Clinic is a large referral center for patients who
exhibit a variety of muscle diseases that cannot be diagnosed or
treated elsewhere. You will see patients two afternoons each week.
You also will participate in patient diagnosis and management with
increasing responsibility as your training year progresses.
Didactic Training
Biweekly journal club meetings are held in the laboratory.
You will present a review of a selected topic several times during
the year.
You also will be responsible for organizing a muscle case conference
for the Department of Neurology twice during the year and present
and discuss muscle biopsy findings at conferences sponsored by other
Mayo Clinic departments such as Rheumatology and Dermatology.
You are encouraged to demonstrate interesting cases to other resident,
fellows and staff throughout the year and attend at least two teaching
conferences or guest lectures each week. These latter are sponsored
by the Department of Neurology.
Research Training
Your research opportunities at Mayo Clinic are outstanding.
During the course of this fellowship, you will design and complete
a research project under close mentorship from one of our clinician-researchers.
Opportunities for both clinical and laboratory-based projects exist.
You will learn about research through observation and participation
in the design and conduct of ongoing clinical trials.
It is anticipated that your research will generate results suitable
for publication in a major neurology, neuromuscular disease subspecialty
or neuropathology journal. It is also expected that you will present
your research results at national or international meetings, for
example, the American Academy of Neurology, American Neurological
Association, International Congress on Neuromuscular Diseases, or
other appropriate venues.
|
