Training for Diagnosing Neurological Disorders

Objective: This is a training protocol. The goal of this protocol is to train fellows in advanced physiological techniques used for diagnosing neurological disorders. A secondary objective of the protocol is to gather normative data for diagnostic neurophysiologic tests.

Study population: Patients and healthy adult volunteers may be studied under this protocol. Patients must have a clinical indication for the diagnostic test. Most patients will be enrolled in a primary NIH protocol, and this protocol will serve as a secondary protocol. Occasionally, patients will be enrolled in this protocol as a primary protocol when they are referred from hospitals that participate in the NINDS fellowship training program. Healthy adults will be studied by fellows-in-training to practice a new testing procedure or to provide normative data when required by changes in instrumentation or laboratory technique.

Design: Testing will be performed during an outpatient clinic visit. One or two of the following procedures may be performed as clinically indicated: single fiber EMG, macro-EMG, near-nerve recording, single-pulse transcranial or peripheral nerve magnetic stimulation, quantitative sensory testing, nerve conduction studies, electromyography, nerve ultrasonography, or autonomic testing.

Outcome measures: This is a training protocol. No research will be carried out under this protocol.

• INCLUSION CRITERIA FOR PATIENTS:

Adult patients, over age 18 years old, with a clinical indication for the diagnostic procedures will be enrolled

• Suspected disorders of neuromuscular transmission, such as myasthenia gravis or
• Suspected Central demyelinating disorders such as multiple sclerosis or
• Suspected Myelopathy or
• Suspected motor neuron disease or
• Suspected Movement disorders that impair intracortical processes or
• Suspected neuropathy or myopathy or
• Suspected autonomic dysfunction

Inclusion criteria

FOR HEALTHY VOLUNTEERS:

Healthy adults, aged 18 years or older, willing to participate

Exclusion criteria

FOR PATIENTS:

• Patients with implanted devices, such as pacemakers, or metal in the cranium (excluding dental work) will be excluded from magnetic stimulation studies.
• Children under age 18 will be excluded, since the goal of this protocol is to provide training experience.
• Subjects who are unable to provide informed consent
• Persons undergoing the autonomic testing will be asked to refrain from smoking, caffeine, alcohol and vigorous exercise 24 hours before the study. Several medications should not be taken 48 hours prior to the study; these include tricyclic antidepressants, antihistamines, cough and cold medications, anti-Parkinson medication, muscle relaxants, anti-psychosis medications, opioid drugs, and blood pressure medications. No one is to stop their prescribed medication without discussion with their primary care physician though the ability to complete all of the autonomic testing may be affected.

Exclusion criteria

FOR HEALTHY VOLUNTEERS:

• Medical conditions that require medications that affect the physiological measures being tested
• History of stroke, peripheral neuropathy or spine surgery
• Implanted devices or metal in the cranium (except dental work) if undergoing magnetic stimulation
• Persons undergoing the autonomic testing will be asked to refrain from smoking, caffeine, alcohol and vigorous exercise 24 hours before the study. Several medications should not be taken 48 hours prior to the study; these include tricyclic antidepressants, antihistamines, cough and cold medications, anti-Parkinson's medication, muscle relaxants, anti-psychosis medications, opioid drugs, and blood pressure medications. No one is to stop their prescribed medication without discussion with their primary care physician and you may be excluded from the study.
• NIH employees and staff may participate, except if they are EMG Section, OCD, NINDS employees.