The movement disorders fellowship is a one year fellowship stressing the clinical evaluation and management of the full range of movement disorders seen in adults. Opportunities will be available to create a customized experience that could additionally include pediatric movement disorders, ataxia clinic, limb EMG training, but these would not necessarily be part of the core experience.
- Evaluation and management of Idiopathic Parkinson's disease
- Early disease: differential diagnosis; motor and non-motor features; neuroprotection; patient education; initiating symptomatic therapy
- Mid-stage disease: management of motor and nonmotor symptoms; use of adjunctive medications
- Advanced disease: management of complicated motor fluctuations with apomorphine, continuous delivery of levodopa, DBS, experimental therapeutics (clinical trials); management of Parkinson's disease psychosis; management of dementia; swallowing and gait safety; home care coordination; end of life issues
Other parkinsonian syndromes
- Diagnostic exam and historical features that are used to clinically diagnose PSP, MSA, CBD and DLB
- Management of complications of atypical parkinsonism
- Understanding prognosis and managing patient expectations, awareness of experimental therapy, importance of brain banks
- Clinical phenomenology that define generalized and focal dystonias
- Application of available treatments for dystonia including oral medications, botulinum toxin, and DBS surgery
- Huntington’s disease and other choreas
- Differential diagnosis of chorea presenting in adults and children
- Diagnosis and management of secondary choreas, such as hemiballism
- Sydenham chorea, other immunological choreas
- Diagnosis and management of Huntington’s disease
- Use of genetic testing to diagnose Huntington's disease and requirements of the predictive Huntington's disease gene testing program
- Familiarity with current experimental approaches for treating Huntington's disease, including symptomatic and neuroprotective agent
- Management of psychosocial, legal, ethical, and other practical management issues in Huntington's disease
- Phenomenology and differential diagnosis of tics in adults and children
- Management of tics, nonmotor features and comorbid behavioral problems in Tourette syndrome
- Clinical features of essential tremor and distinction from other tremor disorders such as Parkinson's disease, dystonic tremor
- Management of essential tremor with oral medications and DBS
- Recognition and management of drug-induced parkinsonism (learn the drugs that can cause DIP)
- Recognition and management of tardive dyskinesia, and other tardive syndromes
- Recognition and management of neuroleptic malignant syndrome, serotonin syndrome, acute dystonic reaction
- Clinical recognition of myoclonus and understanding of anatomical/physiological types (spinal, propriospinal, cortical)
- Recognition of the causes of myoclonus including metabolic derangement, epilepsy, degenerative disease, prion disease, essential myoclonus
- Core clinical features that define restless leg syndrome
- Recognition of primary and secondary restless leg syndrome
- Role of iron in restless leg syndrome
- Management of restless leg syndrome with oral medications
- Clinical diagnosis and use of imaging in hemifacial spasm
- Use of botulinum toxin to manage symptoms of hemifacial spasm
- Ataxias
- Recognition of cerebellar ataxia, sensory ataxia on examination
- Familiarity with the causes of acute, subacute, and chronic causes of ataxia including genetic, parainfectious, paraneoplastic, and structural pathologies
Teaching Tools
Supervised clinics with all attending faculty including:
- General movement disorders clinics
- Extensive hands on training in botulinum toxin injections and DBS programming sessions
- Participation in clinical trial visits to extent allowed by individual protocols
- Optional ataxia clinic
- Attend all DBS surgeries
- Training on proper videotape documentation of MDO
- Competency in use of EHR, documentation, coding, and billing
Minimum Expectations
- Grand rounds presentation
- Organize and prepare materials for video conference and journal club
- Peer review paper submission
- Presentation of abstract at MDS meeting
- Perform CAPSIT evaluations on DBS candidates
- Perform videotape examinations on all new patients