Western University, Canada - London Ontario

| Friday July 3, 2015
1:18 PM

Referral Group Description

The Neuromuscular and ALS/MND clinics

The Neuromuscular (NM) clinic specializes in the diagnosis and management of patients with neuromuscular diseases and is closely allied with the ALS/MND clinic.

Each physician in the Neuromuscular group has specific areas of subspecialty expertise and his/her clinics are held on different days of the week. The NM Nurse Practitioner is involved in the management of most patients with NM disorders.

Disorders seen within the neuromuscular clinic include everything from diseases of the anterior horn cell or motor neuron, spinal nerve roots, peripheral nerves, neuromuscular junction to muscle.

Specific expertise in our clinic includes the diagnosis and management of patients with:
o Anterior horn cell/Motor neuron disorders including ALS, spinal muscular atrophy and other motor neuron disorders (Drs. C. Shoesmith and M. Strong)
o Peripheral neuropathies including autonomic neuropathies, hereditary neuropathies, acquired demyelinating neuropathies such as the Guillain-Barré syndrome (GBS), multifocal motor neuropathy with conduction block and chronic inflammatory demyelinating polyneuropathy (CIDP) (Dr. K. Kimpinski)
o Neuromuscular transmission disorders including myasthenia gravis (MG), congenital myasthenic syndromes and the Lambert Eaton myasthenic syndrome (LEMS) (Dr. M. Nicolle)
o Myopathies including inflammatory, toxic and hereditary myopathies (myotonic disorders, channelopathies and muscular dystrophies) (Dr. S. Venance)
o Rehabilitation issues in patients with NM disorders, peripheral nerve injury, radiculopathy (Dr. T. Doherty)
o Nursing issues for patients with NM disorders (Ms. W. Koopman, RN, [EC]) NP-Adult)

More detailed information about areas of interest, referral process and contact information can be found under individual physician listings (click on the physician name to the right or look under the Faculty tab: Our Neurologists for names of the NM physicians)

Consultations and follow up in the NM or ALS/MND clinic

At the time of the first consultation in the NM clinic or ALS/MND clinic patients are seen by one of the NM or ALS physicians, often with residents or neuromuscular fellows. Follow up appointments are made depending on the need for further investigations or management. NM patients seen in follow up are often seen initially by the nurse practitioner, Ms. Wilma Koopman, RN (EC). For many patients followed in the NM clinics, MS. Koopman provides telephone follow up and advice. Patients with ALS/Motor neuron disorders are seen in consultation and followed in the ALS/MND clinic by the physician and other members of the Multidisciplinary Motor Neuron Diseases team (nursing and multiple allied health professionals).

NM and ALS/MND clinics and LHSC EMG Laboratory

Both the NM and ALS/MND clinics work closely with the EMG laboratory at LHSC and most physicians also see patients and supervise studies done in the EMG laboratory. The EMG laboratory (see separate link for more information including a link to the EMG lab requisition for referrals) has more than 30 years of experience in electrodiagnostic testing for patients with a variety of disorders of the peripheral nervous system, from simple to highly advanced testing for more complex disorders.

Patients with more limited neuromuscular problems (such as focal entrapment neuropathies, radiculopathies) should be referred to the EMG laboratory for consultation and EMG studies, which are generally booked on the same day. More complex NM problems are best referred to the neuromuscular clinic first, with studies arranged by the NM physician usually on the same day that the patient is seen in consultation in the NM or ALS/MND clinic. There is no need to refer a patient separately for EMG studies if they have been referred to one of the physicians in the NM or ALS/MND clinic. To ensure that patients are seen in the most appropriate location, depending on the nature and complexity of the problem consultations to the EMG laboratory may be diverted to a physician in the NM or ALS/MND clinic or vice versa.

Referrals to the NM or ALS/MND clinics

Referrals for specific NM conditions should be made to the NM clinic office or directly to one of the NM physicians, according to the nature of the problem (see above for areas of subspecialty expertise). To take advantage of specific physician expertise, referrals to the NM or ALS/MND clinic may be diverted, following a review of the referral information, internally to the most appropriate physician.

Referrals for ALS/MND should be made to either Dr. Christen Shoesmith or Dr. Michael Strong.

Most of the physicians in the NM clinic also see patients with less well differentiated or general NM disorders. The management of these patients may subsequently be transferred to another physician in the NM clinic once a diagnosis is made, when appropriate.

Research in Neuromuscular disorders

Physicians and nurses in the NM and ALS/MND clinics are involved in research at both a basic science and clinical level in a wide variety of neuromuscular diseases, including clinical trials of drugs and other biological treatments.