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Neuro-Muscular Program
Clinical Activities
The program consists of specialized weekly clinics for the diagnosis and treatment of Myasthenia Gravis, Myopathies, Peripheral Nerve disease, and Amyotrophic Lateral Sclerosis. Patients with peripheral nerve disease and peripheral nerve trauma are referred for neurophysiologic testing from around the province.
The program is closely associated with the Adult Metabolic Diseases Clinic and the ALS Centre at GF Strong. The Vancouver Hospital neurophysiology labs are integrated into the neuromuscular diseases program.
Dr. Gibson and Dr. Mezei participate in monthly Neuroplex meetings and there is a close liaison of the neuromuscular diseases program with the VH Plasma Exchange unit. A donor to the NMDU has enabled the program to fund a part-time clinical nurse educator focused on patient education.
The Neuromuscular Diseases Unit (NMDU) at VGH has a variety of specialized programs:
1. Peripheral Neuropathy Program – Drs. Chapman and Gibson continue to be active in the development of the Peripheral Neuropathy Clinic. They have several ongoing diabetic neuropathy and CIDP trials. The recruitment of Dr. Hannah Briemberg has added her expertise in nerve and muscle biopsy to the program.
2. Myasthenia Gravis Program – This program includes the MG Clinic at VGH which has expanded with the involvement of Drs. Oger, Gibson, Mezei, Chapman and Briemberg. Its current projects include a formal review of the clinical course of antibody negative myasthenia gravis and an epidemiological study of the incidence and course of myasthenia gravis in the Asian BC population.
3. Muscle Diseases Program – Dr. Briemberg additionally brings a new expertise to muscle diseases. Clinical muscle pathology Rounds are scheduled monthly and the NDU at VGH has strengthened its association with the pediatric neuromuscular program with Dr. Briemberg attending the weekly pediatric neuromuscular clinic at BCCH.
4. ALS Program – Drs. Gibson and Eisen have continued their successful activities in fundraising in support of the merged VGH-GF Strong ALS Clinic. These efforts have added to those of UBC, the Vancouver Hospital Foundation and the ALS Society of BC. The new Vancouver Coastal ALS Centre will open at the G.F. Strong site in March 2005. This clinic will stand as a legacy to the many contributions that Dr. Andrew Eisen made in the diagnosis and treatment of ALS patients throughout his career. Dr. Eisen formally retired as the Director of the ALS Clinic in December 2004 with Dr. Charles Krieger assuming the role of Interim Director. In addition to his active involvement in the ALS Clinic, Dr. Charles Krieger continues with his research in the murine mouse model of ALS and examining the role of protein kinases in the disease.
Dr. Michelle Mezei has been active in her role as the Director of Residency Training in the Neuromuscular Program and electromyography. In addition to supervising weekly Neurophysiology Rounds, she is actively involved in the monthly Muscle Pathology Rounds and Clinical Neuromuscular Rounds. Dr. Mezei is further developing her focus in the metabolic myopathies and genetic neuromuscular diseases, attending clinics in the Adult Metabolic Diseases Unit and the Adult Neurogenetics Clinic at UBC.Research Activities
Myasthenia Gravis: Participation in a multinational trial assessing the efficacy of thymectomy in the management of Myasthenia Gravis. Funed by NIH.
Etanercept: Ongoing clinical trials of the evaluation of Etanercept in Dermatomyositis and Talampanel in ALS.
New Drugs: Several clinical trials assessing the efficacy of new drugs in the treatment of neuropathic pain in peripheral neuropathy were completed.
Dr Mezei has ongoing clinical research projects in mitochondrial diseases.
Dr Charles Krieger has continued laboratory studies in the mutant SOD mouse model of ALS.
Teaching Activities
The NMDU is active in resident teaching of clinical neuromuscular disease and neurophysiology. Neurology and Rehabilitation medicine residents are involved in the training program. The program holds weekly rounds for the presentation of neurophysiologic topics and clinical cases and once monthly neuropathology rounds where muscle and peripheral nerve biopsies are reviewed. A comprehensive 2 year neuromuscular fellowship has also been established.
In June 2008, the VH Neuromuscular diseases unit hosted the Canadian Neurologic Sciences Neurophysiologic licensing examinations. Drs Gibson and Chapman hosted the first Western Canada GBS and CIDP Foundation meeting in Vancouver in April 2008. Dr. Chapman is involved in the organization of the first Vancouver Multidisciplinary Neuromuscular Disease group meeting held in April 2009.
Participating Divisional Members
Dr. Briemberg
Dr. Cashman
Dr. Chapman
Dr. Gibson
Dr. Krieger
Dr. Mezei
Dr. Oger