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SPECIALTY CLINICS
Revised May 2009
Ataxia Clinic: Monday afternoons
Referrals: The Ataxia Clinic provides comprehensive diagnostic evaluation and management of patients with postural and movement disorders, with emphasis upon cerebellar disturbances, including the hereditary spinocerebellar ataxias, sporadic olivopontocerebellar atrophy, multiple system atrophy and Friedreich's ataxia. Patients with extrapyramidal disorders, including progressive supranuclear palsy, Parkinson's disease, dementia with Lewy bodies, and Alzheimer's disease also are evaluated. Many patients in this clinic are enrolled in the Michigan Alzheimer's Disease Research Center.
Procedures: New patients and follow ups are seen by the attending physicians in association with neurology residents and fellows. The attendings staff all patients and maintain continuity of care. Patients in this clinic commonly are studied with neuropsychological testing, speech evaluation, balance and vestibular testing, structural imaging with MR scanning and functional imaging with positron emission tomography. Balance and vestibular, speech pathology, neuro-ophthalmology, and laboratory referrals commonly occur as well.
Cerebrovascular Clinic: Thursday mornings
The Cerebrovascular Disorders Clinic of the Department of Neurology provides comprehensive care for patients with cerebrovascular diseases. The Cerebrovascular Disorders Clinic is part of a multidisciplinary team of physicians, nurses and researchers interested in the prevention and treatment of stroke and other vascular processes that affect the brain.
Problems evaluated in the Cerebrovascular Disorders Clinic include ischemic and hemorrhagic stroke, TIA, cerebral venous disease, cerebral aneurysms/vascular malformations, cerebrovascular arterial stenosis or occlusion, stroke risk factor evaluation and modification, and all other cerebrovascular disease.
The care of patients includes neurological evaluation, review of radiological, vascular and laboratory studies and coordination of all necessary diagnostic tests. Stroke prevention, risk factors and warning signs are discussed at each clinic visit. Rapid referral to other specialists is available, and a multidisciplinary Neurovascular Conference reviews complicated problems for the development of a coordinated care plan. Prompt and ongoing dialogue is maintained with referring physicians to coordinate management of patient problems in the most effective manner.
Cognitive Disorders Clinic: Monday mornings, Monday afternoons, Tuesday afternoons (residents), and Thursday mornings.
This clinic is conducted at the East Ann Arbor Clinic.
Referrals: Cognitive Disorders Clinic provides comprehensive diagnosis and management of patients with dementia, particularly Alzheimer's disease. Referrals may come from outside physicians, physicians within the University, families or patients themselves.
Procedures: Patients are seen on Tuesday afternoons by residents in association with attending staff. Patients in this clinic commonly are studied with neuropsychological testing and structural brain imaging. Generally, two clinic visits in addition to these studies are needed to complete an evaluation. To facilitate the evaluation, both visits and neuropsychological testing are all scheduled when the initial appointment is made. Ongoing research projects are available to patients and families.
Epilepsy Clinic: Monday mornings, Friday mornings and Friday afternoons
In most cases, the referral will be handled as a single consultation for formulation of a diagnostic impression or therapeutic plan, with the referring neurologist maintaining continuity of care. Referrals are appropriate for the following problems:
1. Differential diagnosis (e.g., pseudoseizures, syncope, fugue states, etc.)
2. Classification of epileptic seizures
3. Refractory seizures
4. Polypharmacy
5. Drug interaction or unusual metabolism of antiepileptic drugs
6. Epilepsy and pregnancy (preferably patients contemplating pregnancy)
7. Psychosocial complications of epilepsy
Patients referred specifically to the Epilepsy Clinic, or to an Epilepsy Clinic attending, or patients with seizure disorders are scheduled in Epilepsy Clinic.
Procedures:
A. Residents on the clinic rotation participate in Epilepsy Clinic. Residents on the EEG rotation participate Monday and Friday mornings.
Except in cases of extremely refractory seizures, polypharmacy, poorly compliant patients, and patients with psychosocial complications, the residents often may see the patients in follow-up in their own continuity of care clinics. This should be discussed with the attending physician.
B. EEG and epilepsy fellows will see new patients and will be assigned continuity of care of patients with refractory seizures and polypharmacy.
Gail Fromes, R.N., M.S., clinical nurse specialist, sees epilepsy surgery candidates referred from epilepsy faculty and fellows. These patients are sometimes referred for monotherapy anti-epileptic drug trials or vagus nerve stimulation prior to epilepsy surgery; pre-operative and post-operative evaluations. Gail is engaged in activities in the Epilepsy Lab and is also available to see new referrals for any of the following types of patients, as long as the diagnosis and treatment plan are clear: (1) any patient requiring a rapid predetermined medication crossover and frequent follow-up; (2) any stable group home patient who needs only routine follow-up and has stable epilepsy on a stable regimen.
Movement Disorders Clinic: Tuesday mornings
This clinic is conducted at the East Ann Arbor Clinic
Referrals: Movement Disorders Clinic provides diagnosis and treatment for patients with all types of movement disorders.
New patients with the following referral diagnoses will be scheduled in the Movement Disorders Clinic:
Huntington's Disease/Chorea
Parkinson's Disease
Gilles de La Tourette Syndrome
Dystonic States (dystonia musculorum deformans, spasmodic torticollis)
Dyskinesia (oral facial dyskinesia, tardive dyskinesia)
Tremor
Twitches/Tics
Myoclonus
Multiple Sclerosis Clinic: Friday afternoons
The University of Michigan Multiple Sclerosis Clinic provides highly skilled neurological services for the evaluation, treatment, and ongoing care of individuals with multiple sclerosis and other demyelinating diseases of the central nervous system. Care includes neurological assessment, treatment aimed at controlling the progression of multiple sclerosis and symptoms; and, when necessary, assisting with ancillary services, including physical therapy, urological evaluation, and neuroophthalmological consultation. Currently the treatment of multiple sclerosis is expanding and evolving, and patients seen in this clinic receive state-of-the-art disease modifying therapies and management of symptoms related to multiple sclerosis, such as fatigue, spasticity, tremor and urinary difficulties. For patients who choose to be followed in their community or who already have established neurological care, the Clinic provides thoughtful second opinions concerning diagnosis, treatment and management. In addition to an active Clinic, the MS Center conducts clinical research that is relevant to this chronic illness. Research focuses on development of diagnostic assays, improving heat-sensitive symptoms using a cooling device, and testing of new immunotherapies.
Neurogenetic Disorders Clinic: First and second Friday afternoons of each month at East Ann Arbor.
Referrals: The Neurogenetic Disorders Clinic provides evaluation, treatment, and counseling for patients and families with known or suspected inherited and degenerative disorders of the nervous system. Sixteen to twenty patients are evaluated each month. Individuals with a wide variety of inherited neurologic disorders are evaluated in the Neurogenetic Disorders Clinic including those with hereditary spastic paraplegia (autosomal dominant, autosomal recessive, X-linked); muscular dystrophy including facioscapulohumeral and Duchenne’s; paramyotonia congenita; Charco-Marie-Tooth; familial ataxias including Machado-Joseph disease; movement disorders including torsion dystonia, dopa-responsive dystonia, paroxysmal dystonia, choreoathetosis, and Tourette’s syndrome; neurofibromatosis, familial Alzheimer’s disease; Wilson’s disease; familial Creutzfeldt-Jakob disease; Usher’s syndrome; Niemann-Pick disease type C. In addition, many patients with degenerative neurologic disorders of unknown etiology are referred to the Neurogenetic Disorders Clinic to evaluate the possibility that the disorder represents an inherited metabolic disturbance.
Procedures: The Neurogenetic Disorders Clinic is held on the first and second Friday afternoons of each month in the first floor clinic of the Cancer Center/Geriatrics Center Building. New patients and patients returning for follow-up evaluation are seen by Dr. Fink, in association with a neurology resident. All patients are staffed by Dr. Fink and he maintains continuity of care. Many patients participate in ongoing research projects.
Neuromuscular Clinic: Monday mornings, Tuesday mornings, Thursday afternoons
Referrals: New patients with the following referral diagnoses are evaluated by the Neuromuscular Service:
¨ ALS (amyotrophic lateral sclerosis/MND (motor neuron disease)/Lou Gehrig's disease
¨ CIDP (chronic inflammatory demyelinating polyneuropathy)
¨ Eaton-Lambert myasthenic syndrome/Lambert-Eaton myasthenic syndrome (LEMS)
¨ Guillain-Barre syndrome (GBS) (usually direct hospital admission unless seen in follow-up)
¨ Myasthenia gravis (MG)
¨ Myopathies (metabolic, toxic, acquired)
¨ Myotonias (myotonic dystrophy, myotonia congenita)
¨ Multifocal motor neuropathy
¨ Muscular dystrophy (MD)/other dystrophies (adult)
¨ Neuropathies (inherited, toxic, or CIDP)
¨ Polymyositis/dermatomyositis/inclusion body myositis (IBM)
¨ Symptoms including weakness, memory loss, neuropathic pain
Neuro-oncology Clinic: Wednesday afternoons
Referrals: Appropriate referrals include patients with the following diagnoses:
Primary brain or spinal cord tumors (known or suspected)
Cancer metastatic to the nervous system
Neurological complications of cancer treatment
Paraneoplastic syndromes (known or suspected)
Referrals should be discussed with the neuro-oncology clinical nurse specialist.
Clinical Nurse Specialists: Nancy and Linda are the neuro-oncology clinical nurse specialists. They provide continuity of care for the neuro-oncology patients in the inpatient, outpatient and home setting. A holistic approach to care is taken, addressing the biopsychosocial, spiritual, and educational needs of the patient and family from the time of diagnosis through the terminal phase of the disease process. Nancy and Linda coordinate nursing management of patients in study protocols and arrange for the administration of chemotherapy in the outpatient and inpatient settings.
Sleep Disorders Clinic: Monday afternoons, Tuesday afternoons, Thursday mornings, and Friday afternoons. Residents participate mainly on Thursday mornings.
Referrals: New patients with the following problems are scheduled in the Sleep Disorders Clinic:
Excessive daytime sleepiness
Narcolepsy
Snoring
Sleep apnea and other sleep-related breathing disorders
Insomnia
Circadian rhythm disturbances
Parasomnias (nightmares, sleep walking, sleep talking, suspected nocturnal seizures, other unusual nocturnal movements)
Patient referrals may come from outside physicians, other departments and divisions, Department of Neurology physicians, or from patients.
The Sleep Disorders Clinic provides broad exposure to all aspects of sleep disorders medicine, including narcolepsy, sleep-disordered breathing, insomnia, nocturnal seizures, parasomnias, and sleep disorders of progressive neurologic illness. Patients are seen in several weekly Sleep Disorders Clinics and two specialized multidisciplinary settings: an Alternatives to CPAP Clinic and a Pediatric Sleep Disorders Clinic. The Michael S. Aldrich Sleep Disorders Laboratory has nine bedrooms equipped for state-of-the-art digital polysomnography. An additional sleep laboratory with another nine beds is located at KMS. The Clinical Research Center also has two rooms completely equipped for sleep studies. Basic sleep research opportunities are available in the laboratories of Helen Baghdoyan, Ph.D., Ralph Lydic, Ph.D., Mark Opp, Ph.D., and Gina Poe, Ph.D.