Department of Neurology

Milestone 8: Demyelinating Disorders — Patient Care

Specifics about each Level and each Item:  What you do you need to know:
 

Level 2

• Diagnoses common demyelinating disorders

Relapsing Remitting MS
Primary Progressive MS
Secondary Progressive MS
Progressive Relapsing MS
Clinically Isolated Syndrome
Radiologically Isolated Syndrome

• Identifies common presentations suggestive of MS relapse or CIS

Optic Neuritis
Brainstem and Cerebellar Syndromes

INO, Ataxia
VI nerve palsy
Gaze-evoked Nystagmus
Facial sensory symptoms
Vertigo
Trigeminal Neuralgia
Paroxysmal symptoms

Spinal cord syndromes

Partial Transverse Myelitis
Lhermitte sign
Paroxysmal spasms

• Identifies clinical presentations suggestive of Primary Progressive MS

Progressive Myelopathy
Progressive Cognitive decline

• Identifies MRI and CSF findings typical of MS

Typical appearance and location of MS lesions
2010 McDonald Criteria for MRI dissemination in space and time
Interpretation of CSF routine studies, Tourtellotte and OCB

• Recognizes Clinical and Imaging Red Flags* suggestive of alternative diagnoses to MS

Clinical Red Flags (e.g., multiple cranial neuropathies, peripheral neuropathy, persistently monofocal manifestations)

Imaging Red Flags (e.g., meningeal enhancement, persistent gadolinium enhancement and continued enlargement of lesions, simultaneous enhancement of all lesions)

* DH Miller et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler. 2008 November; 14(9): 1157–1174.
* Continuum-Lifelong Learning in Neurology. August 2013 - Volume 19 - Issue 4, Multiple Sclerosis; pp: 922-943)

Level 3

• Recognizes  uncommon demyelinating disorders

NMO spectrum disorder
ADEM
Transverse Myelitis

Idiopathic
Postinfectious
Postvaccination)

 •  Manages common demyelinating disorders

Acute management of Clinically Isolated Syndrome or MS relapse

Use of Disease Modifying Therapies in MS

Symptomatic management of Progressive MS

• Identifies and manages uncommon symptoms of MS

Transient neurologic events (e.g., tonic spasm, paroxysmal
paresthesiae)
Disorders of temperature regulation
Epilepsy
Sleep disorders

Level 4 

• Manages  uncommon demyelinating disorders

NMO spectrum disorder

ADEM

Transverse Myelitis (Idiopathic, Postinfectious, Postvaccination)

Resources for each Level:
 

Dr. Serra's reading list (on UH Intranet - click here)

Level 2 Resources:

• Introduction to Neurology Summer Course

• Teaching rounds, general neurology inpatient and consult service

• Case presentations to faculty in the Continuity Clinics at UHCMC and Wade Park VAMC

• UH MS clinics and Wade Park VAMC Tuesday MS clinic

• Reading

a. Up-To-Date through the core library
b. Continuum-Lifelong Learning in Neurology. August 2013 - Volume 19 - Issue 4, Multiple Sclerosis; pp: 881-1169.
c. Continuum-Lifelong Learning in Neurology. October 2010 - Volume 16 - Issue 5, Multiple Sclerosis; pp: 1-313.
d. Handbook of Multiple Sclerosis Editors: Jeffrey A. Cohen, Alexander Rae-Grant. Publisher: Springer Healthcare; 2nd ed. 2012 edition (November 30, 2013).
e. Chris Polman et al. Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann Neurol. 2011 February; 69(2): 292–302.
f. DH Miller et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler. 2008 November; 14(9): 1157–1174.

Level 3 Resources:

• Teaching rounds, general neurology inpatient and consult service

• Case presentations to faculty in the Continuity Clinics at UHCMC and Wade Park VAMC

• UH MS clinics and Wade Park VAMC Tuesday MS clinic

• Reading

a. Up-To-Date through the core library
b. Continuum-Lifelong Learning in Neurology. August 2013 - Volume 19 - Issue 4, Multiple Sclerosis; pp: 881-1169.
c. Handbook of Multiple Sclerosis Editors: Jeffrey A. Cohen, Alexander Rae-Grant. Publisher: Springer Healthcare; 2nd ed. 2012 edition (November 30, 2013).
d. Multiple Sclerosis Therapeutics. Editors: Jeffrey A. Cohen, Richard A. Rudick. Publisher: Cambridge University Press; 4th edition (November 28, 2011).
e. Multiple Sclerosis and Related Disorders: Diagnosis, Medical Management, and Rehabilitation. Editors: Alexander Rae-Grant MD, Robert Fox MD, Francois Bethoux MD. Publisher: Demos Medical; 1 edition (June 18, 2013).

• CPC, morbidity, mortality conferences
• AAN annual meeting selected courses

Level 4 Resources

• Teaching rounds, general neurology inpatient and consult service

• Case presentations to faculty in the Continuity Clinics at UHCMC and Wade Park VAMC

• UH MS clinics and Wade Park VAMC Tuesday MS clinic

• Reading

a. Up-To-Date through the core library
b. Continuum-Lifelong Learning in Neurology. August 2013 - Volume 19 - Issue 4, Multiple Sclerosis; pp: 881-1169.
c. Multiple Sclerosis and Related Disorders: Diagnosis, Medical Management, and Rehabilitation. Editors: Alexander Rae-Grant MD, Robert Fox MD, Francois Bethoux MD. Publisher: Demos Medical; 1 edition (June 18, 2013).
d. Self-reading
e. CPC, morbidity, mortality conferences
f. AAN annual meeting selected courses