The Neuromuscular Disorders (Muscle Disorders) Fellowship involves a one-year experience with a research component and an optional second year in case of outstanding performance and academic promise. As a Muscle Disorders fellow, you will train primarily in the Muscle Laboratory and see patients in the Neurology Clinic, which is adjacent to the laboratory.

Clinical training

Your clinical training will include diagnosis and management of the entire spectrum of neuromuscular diseases, including:

• Muscle disorders
  • Polymyositis
  • Dermatomyositis
  • Inclusion-body myositis
  • Congential myopathy
  • Metabolic myopathies
  • Mitochondrial myopathy
  • Elevated creatine kinase (CK)
  • Muscular dystrophies
• Neuromuscular junction disorders
  • Myasthenia gravis
  • Congenital Myasthenic syndrome
  • Lambert-Eaton syndrome
  • Botulism

Rotations

During your training, a typical rotation schedule would be:

• Months 1 and 2: Introduction to enzyme histochemistry of muscle for routine analysis
• Months 3 and 4: Immunocytochemistry of muscle for diagnosis and research
• Months 4-6: Introduction to electron microscopy: theory, practice, elements of fine structure
• Months 7-12: Research project employing one or more techniques acquired during the first six months
• Months 1-12: Interpretation of muscle biopsies
• Months 1-6: With program director, you will diagnosis and manage treatment of patients with neuromuscular diseases
• Months 7-12: Independent diagnosis and management of patients with neuromuscular diseases

Rotation descriptions

Enzyme histochemistry

Enzyme histochemistry has become the gold standard for evaluating and diagnosing muscle biopsies. However, its usefulness depends on proper technique. More than 30 histochemical procedures are used for diagnosis. Of these, 15 are done routinely on every muscle specimen. You will learn the preparatory technique and learn to recognize artifacts and pathologic deviations from norm.

Immunocytochemistry

Recently, immunocytochemistry has become increasingly important in the diagnosis of different muscle diseases. Examples of its use include immunolocalization of dystrophin, merosin and sarcoglycan in the muscular dystrophies, immune deposits in myasthenia gravis and dermatomyositis, immunophenotyping of inflammatory myopathies and so on.

Introduction to electron microscopy

Electron microscopy can elucidate pathologic reactions that escape detection by light microscopy. Typical examples are alterations in the neuromuscular junction in myasthenic disorders, microvascular pathology in dermatomyositis, sarcolemmal defects in Duchenne dystrophy, Whipple cells in Whipple's disease, or loss of thick filaments in acute quadriplegic myopathy. You will learn the electron microscopy technique, become familiar with muscle ultrastructure and recognize pathological reactions of muscle at the ultrastructural level.

Research project

After learning basic laboratory techniques, you will embark on a research project. You will be encouraged to initiate the planning of at least one research project and a dialogue prior to the actual project start. Once the project is underway, you will discuss the findings and plans with the program director.

Interpretation of muscle biopsies

More than 1,400 muscle biopsies are read in Mayo Clinic's Muscle Laboratory each year. About 220 of these are from Mayo patients; the remainder comes to Mayo Clinic from other medical centers throughout the United States for processing and interpretation. A second opinion or clinical summary accompanies each specimen.

Biopsy reading sessions are held three times per week and provide an unparalleled opportunity for making clinical-pathological correlations. Virtually every type of muscle disease is observed during your year of training. Frequently, a rare or unusual biopsy finding serves as the basis of a special research project.

A large collection of teaching slides is available for study. The Muscle Laboratory maintains a library of approximately 8,000 frozen muscle biopsy specimens stored under liquid nitrogen. This material is invaluable for special studies on selected diseases.

Diagnosis and management of patients

Mayo Clinic is a large referral center for patients who exhibit a variety of muscle diseases that cannot be diagnosed or treated elsewhere. You will see patients two afternoons each week. You also will participate in patient diagnosis and management with increasing responsibility as your training year progresses.

Didactic training

Biweekly journal club meetings are held in the laboratory. You will present a review of a selected topic several times during the year.

You also will be responsible for organizing a muscle case conference for the Department of Neurology twice during the year and present and discuss muscle biopsy findings at conferences sponsored by other Mayo Clinic departments such as Rheumatology and Dermatology.

You are encouraged to demonstrate interesting cases to other resident, fellows and staff throughout the year and attend at least two teaching conferences or guest lectures each week. These latter are sponsored by the Department of Neurology.

Research training

Your research opportunities at Mayo Clinic are outstanding. During the course of this fellowship, you will design and complete a research project under close mentorship from one of our clinician-researchers. Opportunities for both clinical and laboratory-based projects exist.

You will learn about research through observation and participation in the design and conduct of ongoing clinical trials.

It is anticipated that your research will generate results suitable for publication in a major neurology, neuromuscular disease subspecialty or neuropathology journal. It is also expected that you will present your research results at national or international meetings, for example, the American Academy of Neurology, American Neurological Association, International Congress on Neuromuscular Diseases, or other appropriate venues.