Neuromuscular Division

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Overview:

The Neuromuscular division under the Department of Neurology focusses on the management of diseases of the peripheral nervous system: anterior horn cells, nerves, neuromuscular junctions and muscle. The diseases commonly managed by us are muscle diseases (myopathies), myasthenia gravis, acquired and chronic demyelinating neuropathies (Guillain Barre Syndrome and CIDP – chronic inflammatory demyelinating polyneuropathy), peripheral polyneuropathies and plexopathies.

Services:

The Division provides both inpatient and outpatient services to patients with neuromuscular disorders. New patients are registered in the General Neurology Clinic (on all working days from Monday to Friday) and then channelled to either inpatient care or follow up under the special team as needed.

Neuromuscular Clinic:

The Speciality Clinic is held once a week on Tuesdays from 10 am to 2 pm. Patients previously registered here are reviewed and followed up in this clinic. A team for physiotherapy, occupational therapy and speech therapy work together with the doctors to provide optimal care to the patients.

Inpatient services:

Patients requiring detailed evaluation and discussion as well as certain therapeutic services are admitted in the wards and intensive care units (ICUs) under the department of Neurology. We have a team of neuromuscular specialists, Post-Doctoral Fellows and Residents along with the supporting staff to cater to the patients.

Electrophysiology laboratory:

We have a state of the art facility for doing nerve conduction studies (NCS), electromyography (EMG), repetitive nerve stimulation (RNS) and evoked potentials (EP). We have two EMG machines (Nikolet Viking Select 4 channel and 2 channel machines) and one 8 channel machine to record evoked potentials (Nihon Kohden Neuropack M1 – MEB – 9200 K). The lab is run by experienced technical staff under the supervision of the faculty. Routine as well as uncommon nerve studies are undertaken in the department. The laboratory also performs advanced studies including voluntary and stimulation single fibre EMG. The appointment for NCS/ EMG studies are obtained from the Medical Records Division.

Neuropathology and immunology:

The Neuromuscular division is supported by the Neuropathology section for processing and reporting of muscle and nerve biopsies. In addition, many immunological studies including Aquaporin IgG, ganglioside antibodies, acetyl choline receptor antibody and muscle specific kinase (MuSK) antibody are performed here.

Genetics:

The division is currently actively involved in research activities in genetics of Neuromuscular disorders in collaboration with genetic centres.

Other integrated services:

The institute provides Neurorehabilitation services for Neuromuscular disorders and is one of the major operating centres for thymectomies in myasthenia gravis.

Research and academic programmes:

Post Doctoral Fellowship Programme:

The Division offers a one year Post Doctoral Fellowship (PDF) programme to candidates who have completed DM Neurology or equivalent through a competitive interview. The PDFs are given the opportunity to manage and discuss difficult neuromuscular cases and are encouraged to work in innovative research projects.

The goals of the PDF Programme are

  • i. Training in the evaluation, diagnosis and management of different neuromuscular disorders including understanding the principles of motor unit physiology and the myoneural junction.
  • ii. Working and associating with a team conducting muscle and nerve clinic of international standards with a focus on follow up, counselling and physical rehabilitation methods.
  • iii. Exposure to activities of the EMG lab and plan a focussed ENMG study: interpretation of ENMG abnormalities in health and neuromuscular disorders mainly myasthenia gravis, motor neuron disease, peripheral neuropathies and muscular dystrophies.
  • iv. Exposure to clinical genetics in relation to neuromuscular disorders and interpretation of pedigrees and molecular studies including genetic counselling.
  • v. Participation in the conduct and meaningful interpretation of muscle and nerve biopsies in collaboration with the department of neuropathology, exposure to various immunocytochemistry stains, preparing the sections for staining.
  • vi. Neuroimmunology of immune mediated neuropathies and the methodology of plasma exchange in the neurointensive care unit and the care of thymectomy patients with myasthenia gravis.

The current PDF, Dr Deepak Menon, is conducting research on genetics of motor neuron diseases and standardization of newer techniques of electrophysiology.

Resident training:

The Division participates actively in the training of DM Neurology residents and observers in Electrophysiology. A Neuromuscular discussion is conducted twice a week to discuss interesting journals and clinical cases. A Neurorehabilitation forum formed by neurologists, Physiatrist, occupational therapist, speech therapist, medico-social worker and residents is conducted every week to plan rehabilitation care of patients.

Research activities:

Many intramural research activities are ongoing in the department on motor neuron disease, electrophysiological techniques in myasthenia gravis and Guillain Barre syndrome.

Faculty in charge:
  • Dr Muralidharan Nair, Professor and Head, Department of Neurology
  • Dr Abraham Kuruvilla, Professor of Neurology
  • Dr Sruthi S Nair, Assistant Professor of Neurology
Contact details:

To book an appointment, contact 0471-2524621