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| Neuromuscular |
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Patient Population
The Neuromuscular Clinic at Toronto Western Hospital specializes in
the tertiary care and research of patients with disorders of the nerve,
muscle, and neuromuscular junction. The clinic is a tertiary referral
Centre for many neurologists (including other neuromuscular specialists)
in Ontario and across Canada. It's the largest program in Canada for
management of patients with myasthenia gravis.
Approximately 3,500 patients attend this clinic annually. About 1,600
procedures are performed annually including highly specialized investigations
such as single fibre electromyography (EMG) and quantitative EMG. To improve
efficiency and service, the EMG laboratory has state-of-the-art electrodiagnostic
equipment, with extensive networking and immediate reporting capabilities.
Education
The clinic plays an important role in teaching at the post-graduate,
medical school and undergraduate levels. Fellows in neuromuscular disorders,
neurology residents, medical residents and summer students all learn
about the investigation and care of patients with nerve, muscle and
neuromuscular diseases. These trainees participate in important clinical
research projects involving neuromuscular patients.
Research
Research activities are focused on new treatments for patients with:
diabetic neuropathy, inflammatory demyelinating polyneuropathy (acute
and chronic), and myasthenia gravis (MG).
- We have defined the optimal methodology for electrophysiolgocial testing
in neuropathy trials. Our studies have helped establish the major
role of electrodiagnositic evaluation in the assessment of patients
with chronic
polyneuropathy.
- We are completing a large-scale screening program
in approximately 500 diabetic patients to assess the optimal simple
clinical test for the detection
of diabetic neuropathy in the general diabetes clinic or physician's
office.
- We are actively investigating aspects of autonomic nervous
system control and quantitative sensory function in patients with
diabetic neuropathy.
- Multiple therapeutic drugs for diabetic neuropathy
have been tested including: aldose reductase inhibitors (sorbinil,
statil, FK-366, zopolrestat, zenarestat),
non-specific metabolic drugs (acetyl-l-carnitine), neurotrophic factors
(nerve growth factor) and phospholipase kinase C inhibitor (PKCi).
Zopolrestat, zenarestat and PKCi trials are ongoing.
- Studies of
painful symptom treatment in patients with diabetic neuropathy
have been completed in the clinic and a study on the effectiveness
of a new drug, pregabalin, in painful symptoms is underway.
- In patients
with MG, we have documented a comparable long-term clinical
outcome after transcervical thymectomy as compared to more invasive
surgical approaches. Our experience in MG patients with thymoma
has been published.
- An active area of clinical investigation is the
effectiveness of different immunomodulation therapies in patients
with motor neuropathies, inflammatory
demyelinating polyneuropathies (acute and chronic). Currently, we
are investigating the usefulness of the new immune suppressive agent,
neoral
in the treatment of patients with autoimmune neuromuscular disorders
(MG, polymyositis and chronic inflammatory demyelinating polyneuropathy
[CIDP]).
Clinical research comparing different immunomodulation therapies
(intravenous immunoglobulin and plasma exchange) in patients with CIDP
is planned.
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