Neuromuscular Medicine is a sub-discipline of neurology that deals with the pathophysiology, genetics, pathology, diagnosis, and treatment of neuromuscular disorders at a level significantly beyond the training and knowledge expected of a general neurologist or child neurologist. This specialized knowledge is utilized in the clinical evaluation, and management of disorders of the motor neuron, nerve roots, peripheral nerves, neuromuscular junction and muscle that affect patients of all ages.

Diagnostic procedures relevant to this field include nerve conduction studies and electromyography, autonomic testing; nerve, muscle, and skin biopsy; genetic testing, nerve and muscle imaging, and immunologic testing.  Therapeutic modalities include pharmacologic therapies, immunomodulatory therapies (immunosuppressive drugs, plasmapheresis and IVIg) and rehabilitation of neuromuscular disorders.

The mission of the Neuromuscular Section is to provide core competency standards of training for the evaluation and treatment of patients with neuromuscular disorders; to reduce death and disability for these diseases; and to improve treatment of patients with neuromuscular disorders. These disorders include:

• Peripheral Neuropathies

• • Charcot-Marie Tooth Disease and other Inherited Neuropathies
  • Guillain Barré Syndrome
  • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), and other immune mediated neuropathies
  • Diabetic Neuropathy
  • Paraproteinemic neuropathies
  • POEMS syndrome
  • Cryptogenic sensory polyneuropathies
  • Neuropathies of undetermined cause
  • Small fiber neuropathies
  • Cranial neuropathies
  • Entrapment neuropathies
  • Multiple mononeuropathies including multifocal motor neuropathies
  • Cervical radiculopathies
  • Brachial plexopathies
  • Lumbar radiculopathies
  • Lumbar plexopathies
  • Chemotherapy induced polyneuropathy
  • Critical illness polyneuropathy
  • Peripheral nerve hyperexcitability syndromes

• Motor Neuron Diseases
  • Amyotrophic Lateral Sclerosis
  • Primary lateral sclerosis
  • Progressive bulbar palsy
  • Spinobulbar muscular atrophy
  • Progressive muscular atrophy
  • Paraneoplastic motor neuron disease
• Neuromuscular Junction Disorders
  • Myasthenia Gravis
  • Lambert-Eaton Myasthenic Syndrome
  • Congenital Myasthenic Syndromes
• Muscle Disorders and Pathology
  • Muscular Dystrophies
  • Myotonic dystrophies
  • Congenital Myopathies
  • Muscle Channelopathies and disorders of periodic paralysis
  • Idiopathic inflammatory myopathies including polymyositis, dermatomyositis, statin associated autoimmune myopathy, and inclusion body myositis
  • Metabolic myopathies
  • Toxic myopathies
  • Critical illness myopathies

Charcot-Marie-Tooth Diseases (CMT) Clinic

This clinic is dedicated specifically to patients with inherited peripheral nerve diseases, also called CMT. It is a multi-disciplinary clinic staffed by a Neurologist, Genetic Counselor, Physical Therapist, Orthotic Specialist, Clinical Electrophysiologist and Assistant Device Specialist. Patient care will be executed in an efficient and convenient "one-step shopping" fashion within the same day of the visit. The clinic has been recognized by American CMT Association as CMT Center of Excellence (CMTA Centers of Excellence). This clinic is a part of Inherited Neuropathy Consortium (INC) and also supported by Muscular Dystrophy Association (MDA). Our CMT Clinic is directed by Ryan Castoro, MD.

Our Objectives:

We aim to be actively involved in clinical and basic science research that will improve our knowledge of the neuromuscular disorders and lead to new treatments for patients, to utilize the knowledge gained from research in the care of our patients, to work with local, national and international physicians, scientists and patient organizations to improve the lives of people with neuromuscular disorders, and to educate medical students, residents, fellows and scientists in the workings of the peripheral nervous system and neuromuscular disorders.

We aim to train residents and fellows how to perform and document a comprehensive history and examination, formulate differential diagnosis and investigate patients with neuromuscular disorders. Education in the application and relevance of investigative procedures and interpretation in the diagnosis of neurologic disease, including the following: motor and sensory nerve conduction studies, needle electromyography, nerve and muscle pathology, cutaneous nerve fiber pathology, CSF analysis, interpret neuromuscular genetic testing and radiographic studies. Exposure to single fiber electromyography, skin pathology and autonomic function is included. Skin biopsy is the pathologic gold standard for diagnosing small fiber neuropathy.  Intraepidermal nerve fiber density (IENFD) is the criterion most accepted to support a clinical diagnosis of small fiber neuropathy.  Also it provides quantitative analysis of autonomic fibers in sweat glands by determining the sweat gland nerve fiber density (SGNFD), thus evaluating for the involvement of the autonomic nervous system.  EMG/NCS:

What to Expect During Nerve Conduction Study and EMG Test

Holden Neurophysiology Lab
EEG/EMG/EP
4201 St. Antoine, University-Health Center-8B
Detroit, MI 48201

For Appointments - 800 966-9644
Monday Friday | 8:30 a.m. 5:00 p.m.