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MOVEMENT ELECTIVE

Purpose: The goal of the rotation in Movement Disorders is to become familiar with the fundamental components of recognizing, accurately diagnosing, and treating a range of movement disorders found in general clinical practice.

LOGISTICS

Faculty Supervisors: Dr. Lisa Shulman (Division Director), Dr. Stephen Reich, Dr. Joseph Savitt, Dr. Rainer von Coelln

Responsibilities:  At least 2 weeks prior to the rotation, the resident should contact Dr. Shulman to let her know you are on the rotation. Residents will be expected to see patients in outpatient clinic in the Frenkil building with each of the movement disorder specialists throughout the week. Residents will be expected to learn to perform a thorough and accurate neurologic history and examination on adult patients with movement disorders e.g., essential tremor, Parkininson’s disease, dystonia, and learn how to initiate the appropriate diagnostic evaluation for these patients. They will discuss basic pathophysiological mechanisms including the anatomic location of select movement disorders, the relevant neurochemical feature, and the known neurophysiological consequences on brain function that leads to abnormal movements. Residents will discuss and initiate treatment strategies for movement disorders including essential tremor, Parkinson’s disease, dystonia, as well as assessment of Movement Disorder emergencies e.g.,  acute dystonic reactions. Residents will learn to initiate appropriate treatment of common non-motor components of movement disorders.

SYLLABUS 

Competency-based Goals/Objectives: At the end of the rotation, residents will be expected achieve the following competencies and milestones.

PATIENT CARE

  1. Perform a thorough and accurate neurologic history and examination on an adult patient with a Movement Disorder.

  2. Initiate the appropriate diagnostic evaluation of most patients who present with both common and uncommon Movement Disorders in both the inpatient and outpatient setting.

  3. Initiate treatment of common Movement Disorders that present in the inpatient and outpatient setting, including Movement Disorder emergencies.

  4. Initiate treatment of common non-motor components of movement disorders

  5. Discuss appropriate patients for surgical treatments of movement disorders.

  6. Discuss appropriate patients for botulinum toxin injections

  7. Recognize and distinguish functional movement disorders

MEDICAL KNOWLEDGE

  1. Clinically classify abnormal movements by phenomenology: parkinsonism, chorea, tremor, dystonia, tics, ataxia, myoclonus and others.

  2. Construct a differential diagnosis for patients with each of the broad categories of movement disorders

  3. Formulate a diagnostic strategy for patients with movement disorders.

  4. Describe non-motor components of movement disorders including behavioral, cognitive, autonomic and other features.

  5. Describe basic principles of neuroanatomy, neuropathology and neuropharmacology as they pertain to Movement Disorders.

  6. List side effects of common Movement Disorder therapies.

  7. Describe the indications for botulinum toxin injection therapy

  8. Perform basic interpretation of common neurologic imaging studies of the brain and spine (MRI and CT) in patients with Movement Disorders.

REQUIRED READING

AAN PRACTICE PARAMETERS

  1. Treatment of Restless Leg Syndrome

  2. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache

  3. Evidence-based guideline: Treatment of tardive syndromes

  4. Evidence-based guideline update: Treatment of essential tremor

CONTINUUM

  1. Movement Disorders August 2019 (or most recent version if/when updated)