Neuromuscular Program

Overview

Neuromuscular Diseases are those that affect nervous system structures outside of the brain and the spinal cord pathways going to and from the brain. This covers a wide range of conditions, including: ALS, Myasthenia Gravis, Chronic Inflammatory Demyelinating polyneuropathy, Myopathies, Guillan Barre, muscular dystrophies, and spinal muscular atrophies, to name a few.

The Neuromuscular Program in the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services, provides innovative diagnostic evaluation and multidisciplinary therapeutic services for people with these disorders of peripheral nerves, muscles, and neuromuscular junction. The integration of various health care resources both within and out of the Calgary zone is fundamental in the provision of comprehensive and coordinated care to treat these diseases. Through the development of numerous partnerships and collaborations, the Neuromuscular Program continues to impact a large patient population in our community and to enhance care for our patients.

Faculty

Dr. Douglas Zochodne, Neurologist and Director, Neuromuscular Clinic
Dr. Lawrence Korngut, Neurologist
Dr. Keith Brownell, Neurologist
Dr. Cory Toth, Neurologist
Dr. Chris White, Neurologist

Research Themes

Axon Biology and Nerve Regeneration
Dr. Toth’s main research interests lie in understanding the contributions of RAGE (a molecule much more common in the diabetic brain than in a normal brain, that causes nerve cells to shrink, lose their ability to function, and continue to live on in a dysfunctional way) and insulin deficiency to the development of white matter changes, brain atrophy, and cognitive decline in the diabetic brain (both in type I and type II forms of diabetes).  Specifically, Dr. Toth is interested in two main pathways in this neurodegenerative condition: a) the role of insulin deficiency, and tb) the role of advanced glycation end products and their receptor (RAGE). He also investigates experimental diabetic neuropathy and mouse models of nerve regeneration, as well as etiologies of peripheral neuropathies and neuropathic plan.

Dr. Toth’s research initiatives have led to collaborations with local and international researchers regarding problems in nerve regeneration, neuropathic pain, and motor neuron diseases. His research is funded by Alberta Innovates Health Solutions (formerly Alberta Heritage Foundation for Medical Research or AHFMR), as a Clinical Investigator and by the Juvenile Diabetes Research Foundation. He has also received research funding support from the University of Calgary, Alberta Health Services, the Action Committee for Neuropathic Pain, Pfizer Canada, Purdue Pharma Canada, and Talecris Canada.

Sensory neurons, insulin, and experimental diabetes
Chronic diabetes causes slow, but progressive damage of nerve cells (diabetic neuropathy), resulting in pain and loss of sensation in the hands and feet. Dr. Douglas Zochodne investigates the cause of diabetic nerve damage and why nerves that are injured in diabetic patients regenerate poorly.

Current work in his research laboratory at the University of Calgary examines the role of local molecular players in the microenvironment of an injured and regenerating peripheral nerve. Dr. Zochodne and his team are also looking into the pathogenesis of experimental diabetic polyneuropathy and associated regenerative failure in diabetic nerves.

Dr. Zochodne’s research is funded by Alberta innovates Health Solutions (formerly the Alberta Heritage Foundation for Medical Research or AHFMR), the Canadian Institutes of Health Research (CIHR), the Canadian Diabetes Association (CDA), the Muscular Dystrophy Association of Canada (MDAC), National Institutes of Health (NIH), and the Natural Science and Engineering Research Council (NSERC).

Funding/Grants

2008 Research Funding: Lab based
Number of External Project Grants: 8
External Personnel Awards: 5 (excluding summer studentships)
Canadian Institutes of Health Research (CIHR); 3 grants
Canadian Diabetes Association (CDA)
Juvenile Diabetes Research Foundation (JDRF)
Natural Sciences and Engineering Research Council of Canada (NSERC)
Alberta Heritage Foundation for Medical Research (AHFMR) - Scientist, Clinical Investigator, Post-doctoral Fellowships, Graduate Studentships, Summer studentships
National Institutes of Health (NIH)

2008 Research Funding: Clinical trials
Number of Trials: 8
Industry partners: Johnson and Johnson, Talecris, Pfizer, Valeant, Purdue Juvenile Diabetes Research Foundation (JDRF), National Institutes of Health (NIH), Lundbeck, and the University of Alberta ALS Society of Canada

Publications

Brussee V, Guo GF, Dong YY, Cheng C, Martinez JA, Smith D, Glazner GW, Fernyhough P, Zochodne DW. Distal degenerative sensory neuropathy in a long term type 2 diabetes rat model. Diabetes 57(6):1664-73, 2008.
Cheng C, Webber CA, Wang J, Xu YQ, Martinez JA, Liu WQ, McDonald D, Guo GF, Nguyen MD, Zochodne DW. Activated RHOA and peripheral axon regeneration. Experimental Neurology 212(2):358-69, 2008
Hauck LJ, White C, Feasby TE, Zochodne DW, Svenson LW, Hill MD Incidence of Guillain-Barré syndrome in Alberta, Canada: an administrative data study. J Neurol Neurosurg Psychiatry. 2008 Mar; 79(3):318-20
Toth C, Shim SY, Wang J, Jiang Y, Neumayer G, Liu W-Q, Martinez J, Zochodne D, Nguyen. MD. Ndel1 promotes axon regeneration via intermediate filaments. PLoS ONE 3(4):e2014,2008
Toth C. Epidemiology of Neurological Sports Injuries, Neurologic Clinics, February 2008, 26(1):1.31.

Toth C. Neuroepidemiology of Sports Injury, Trauma and Neurology, 2nd edition, Oxford Press, London, Chapter 25, 479-524

Toth C. Peripheral Nerve Injuries in Sports and Recreation, Neurologic Clinics, February 2008, 26(1): 89-113.

Toth C, Au S. A prospective identification of neuropathic pain in specific peripheral neuropathy syndromes and response to pharmacological therapy. Pain 2008 Sep 15;138(3):657-66.

Toth C, Lee HK, Samuels BA, Shim SY, Liu WQ, Martinez J, Xu Y, Ayala R, Wang J, Zochodne D, Tsai L and Nguyen MD. Ndel1 promotes axon regeneration via intermediate filaments, PLOS One, 2008 Apr 23;3(4):e2014.

Toth C, Martinez JA, Chen YY,  Diggle J,  Fang Q,  Ramji N, Hoke A,  Zochodne DW. Local erythropoietin signalling enhances regeneration in peripheral axons, Neuroscience, 2008;154(2):767-83

Toth C, Rong LL, Yang C, Martinez J, Song F, Ramji N, Brussee V, Liu W, Durand J,Nguyen MD, Schmidt AM, Zochodne DW. RAGE and experimental diabetic neuropathy. Diabetes. 2008 Apr; 57(4):1002-17.
Webber CW, Xu YQ, Vanneste KJ, Martinez JA, Verge VM, Zochodne DW. Guiding adult mammalian sensory axons during regeneration. Journal of Neuropathology and Experimental Neurology 67(3): 212-22, 2008
Xu QG, Midha R, Martinez JA, Guo GF, Zochodne DW.  Facilitated sprouting in a peripheral nerve injury.  Neuroscience 152(4):877-87,2008
Zochodne DW. Diabetic polyneuropathy. An update. Current Opinion in Neurology  21(5):527-33. 2008
Zochodne DW, Ramji N, Toth C. Neuronal targeting in diabetes mellitus: a story of sensory neurons and motor neurons. Neuroscientist. 2008 Aug;14(4):311-8.

The Neuromuscular Clinic

Established in 1992, the Neuromuscular Clinic focuses on the assessment, medical management, and rehabilitation needs of people with neuromuscular disorders (e.g., Myasthenia Gravis, Chronic Inflammatory Demyelinating polyneuropathy, Myopathies, Guillan Barre, muscular dystrophies, spinal muscular atrophies, etc.).

Our multi-dsiciplianry clinic - comprised of neurologists, nurses, research associates, allied health care professionals, and administrative staff - collaborates with a variety of services within Alberta Health Services to provide holistic patient-centred health care. This service is also extended through the use of telenursing, a unique healthcare format that allows nurses to assist in monitoring illness progression and engage in referrals and consultations for patients from a variety of different locations. In addition, our external partnerships with organizations such as the Muscular Dystrophy Association of Canada, the University of British Columbia Neuroimmunology Laboratories, and the Calgary Neuropathy Association, allows us to bring together diverse groups vital in ensuring and enhancing continuity of patient care,  promoting the co-ordination of comprehensive, community-based service delivery.

Neuromuscular Clinic Principles
The following principles are incorporated into service delivery by the Neuromuscular Clinic:
1. Proactive approach to patient-care management in order to prevent and/or minimize acute care admissions
2. Foster a patient-centred focus to all Program operations and development
3. Incorporate patient and population focused interventions for chronic disease management
4. Promote self management of chronic symptoms
5. Address and support behavioural and psychosocial issues for patients, their families, and/or their caregivers
6. Provide expertise in the treatment and management of Neuromuscular Diseases to the community at large
7. Facilitate research to address the disabilities posed by Neuromuscular Disease

Services offered at the Neuromuscular Clinic include:
> Pre-diagnostic and diagnostic information and support to patients and their family
> Assessment and diagnostic testing - including EMG/NCS (electromyography/nerve conduction studies
> Coordination of neurological treatment and symptom management
> Telephone consultation and liaison with community agencies regarding the care of the patient
> Expert consultation and advice to other health care providers throughout the continuum of the disease.
> The clinic functions as a resource of expertise in the medical diagnosis and treatment of neuromuscular conditions and diseases.

*PLEASE NOTE THAT ALL REFERRALS TO THE NEUROMUSCULAR CLINIC ARE PHYSICIAN BASED*

To Make a Referral to the Neuromuscular Clinic
Please send patient full demographics with patient contact information, recent progess notes (including current medications and treatments), and all relevant diagnostic imaging and lab results. Fax complete referral to 403-270-8830.

Your referral will be reviewed and notice sent to your office via fax, indicating a time range in which we will see your patient. No appointment dates and times are provided at this time, as our clinic only books patient appointments three months in advance. We will contact your patient directly one month prior to their scheduled appointment. All patients receive written notice regarding their appointment information, as well as information on our service, and directions to our clinic.
Wait times for non-urgent Neuromuscular concerns can be anywhere from 4-12 months.

Neuromuscular clinic
3350 Hospital Drive N.W.
Calgary, AB T2N 4N1
Fax# 403-270-8830
Additional Inquires/Referral Information: 403-944-4418

Neuropathic Pain (NeP) Clinic

About the Clinic
The Neuropathic Pain (NeP) Clinic specializes in the assessment and management of people with disorders of the nervous system leading to neuropathic pain and its complications.  Patients diagnosed with diabetic peripheral neuropathy are a majority of the client population. 

Conditions Assessed and Managed
We see and manage patients with forms of NeP – that is, pain that is the result of a disease or lesion within the peripheral or central nervous system.

Staff and Research
There are currently three neurologists working within this clinic who have a special interest in the care and research of patients with NeP. Teaching and research are important aspects of the NeP Clinic.  As part of the clinic and the unique population of this condition, many research projects are ongoing. 

Referral Process
*Patients attending the clinic are from a physician referral.*

Please fax a complete referral to 403-270-8830 with relevant diagnostic information.  The referral will be reviewed and if appropriate, a letter will be sent informing the patient of their upcoming appointment.  The average waiting period to be seen can be up to one year. 

Clinic Address
The NeP Clinic is located in the Health Sciences Centre (HSC) at the Foothills Medical Centre (FMC). 

Address:     

Area 3 – Health Sciences Centre
Foothills Medical Centre
3350 Hospital Drive N.W.
Calgary, AB  T2N 4N1
Telephone:      403-944-8734
Fax:        403-270-8830
E-mail:    theNePClinic@albertahealthservices.ca