Report from Dr Eugeniu Gavriliuc from Moldova visiting the Department of Neurology 2, Hôpital Pitié-Salpêtrière in Paris, France under the supervision of Professor Jean-Marc Léger.
First of all, I would like to emphasise that fact that the educational programme that I performed within the Department of Neurology 2, Reference Centre Rare Neuromuscular Diseases, Hôpital Pitié-Salpêtrière was a useful and productive experience for me, which will be extremely beneficial in my future professional activity.
During my visit of 6 weeks to the Reference Centre Rare Neuromuscular Diseases, I took part at various clinical and scientific activities. I assisted at the consultations hold by doctor Jean Marc Léger of the patients with peripheral neuropathies. I assisted to the clinical consultation of patients with symptoms and signs of autoimmune peripheral diseases such as chronic inflammatory demyelynating polyradiculoneuropahty (CIDP), CIDP variants with monoclonal gammopathy and antibodies anti-myelin (anti-MAG), multifocal motor neuropathy (MMN) and axonal neuropathies.
My current research doctoral project is entitled: The clinical, electro physiological and morphological characteristics of atypical chronic inflammatory demyelinating polyneuropathies (CIDP). That’s why a special attention I gave to the patients with atypical CIDP according to the EFNS/ENS Guideline 2010. With the permission of Dr Léger, I collected and systematised the medical records of some patients with typical and atypical CIDP. All this data will be of a great aid to fulfill my scientific research and to create a national diagnosis protocol of CIDP patients in my country.
I took part in the patients neurological status examination under the supervision of a senior neurologist. These patients were either with suspicion of peripheral neuropathies or already diagnosed with these diseases but under immunomodulator treatment for CIDP and MMN (intravenous perfusion of immunoglobulins).
I assisted at the consultation of Dr Sara-Louis Bernard, specialist in hereditary neuropathies. I participated at the examination, genetic diagnosis and rehabilitation procedures of patients with hereditary peripheral neuropathies (Charcot-Marie-Tooth), observing their various phenotypes and the complexity of their follow up.
I attended electrophysiological investigations: Motor nerve conduction study, sensory nerve conduction study, F-wave study, Repetitive Nerve Stimulation, and Electromyography. I participated in the reunion of experts in peripheral neuropathies concerning clinical cases of higher complexity, followed up in the Pitié-Salpêtrière Hospital.
A very important peculiarity of the EFNS Department to Department Programme is the fact that I have enlarged my knowledge regarding the examination of patients with neuromuscular diseases and the neurophysiological methods. This will be of a great support for me and I will subsequently put them into practice in my country. I had also access to various articles, atlases, and books of the department where I gathered a lot of new information.
According to the gained experience and the acquired skills, I would like to emphasise the fact that the educational programme performed within the Department of Neurology 2, Reference Centre Rare Neuromuscular Diseases, Hôpital Pitié-Salpêtrière was an efficient, practical and accomplished one.
I gained important experience during this period of time and that is why I am extremely grateful to Dr Jean-Marc Léger, who accepted me within the Department of Neurology and who offered me this unique chance to earn this experience.
As concerns money expenses: my general sum for accommodation in Paris was of average 900 euro/6 weeks. The grant offered by the EFNS Department to Department Programme helped me a lot to deal with all the necessary expenses for boarding.
Dr Eugeniu Gavriliuc
Report from Dr Alexander Chervyakov from Moscow, Russia visiting the Inselspital of the Bern University Hospital, Switzerland under the supervision of Professor Dr Claudio Bassetti.
I spent a nice 6 weeks in one of the biggest clinics in Switzerland – Inselspital – from October 13 until November 24, 2014.
The Inselspital was founded in 1354 and is almost unique in its deep-rootedness within the community. The Inselspital has approximately 7000 members of staff and around 40,000 inpatients each year receive medical and individual nursing care.
In Inselspital Neurocentre includes the Department of Neurology, together with the Department of Neurosurgery of the University Institute for Diagnostic and Interventional Neuroradiology, the Department of Pediatric Neurology, the University Department of Pediatrics and the University Psychiatric Services. 25 physicians, 33 medical assistants and more than 116 non-physician health care professionals work at the Neurocentre. Areas: emergency and Neuro Intensive Care Medicine, stroke, movement disorders, sleep/epilepsy.
I started my practise at the EMG Department (Prof K. Rosler). I was there from October 13 until October 29 and took part in the EMG examination of patients, discussion their problems, EMG results, diagnoses, future plans and treatments. I was able to look at all types of EMG examination: needle EMG, examination of nerve conductive, motor evoked potentials, triple stimulation, transcranial magnetic stimulation, SWEAT examination, and Blink Reflex. I saw something new to me: the quantitative analysis of a needle EMG record, the widespread use of needles for nerve conductive examination, and triple stimulation examination.
The second course was at the EEG department from October 30 until November 16 (Prof J. Mathis). Every Monday and Tuesday morning together with the residents I examined patients with epilepsy in the out-patient department. Monday and Tuesday evening and all other days I took part in record and analysis EEG, polysomnography, invasive deep EEG record. Also sometimes we performed an EEG at the critical care department and emergency department.
The third step was at the rehabilitation department (Prof R. Muri) with TMS laboratory from November 17 until October 24. I took part in laboratory meetings, some TMS experiments with healthy respondents and professor’s rounds (visite).
One day I took part in the presurgical mappingof a patient with brain tumour with navigation transcranial magnetic stimulation with Dr Schucht. It was really interesting because I use navigated TMS in my routine work in Moscow. Also, every week I took part in department meetings, colloquiums and conferences.
I was lucky enough to spend a some weekends in Switzerland´s incomparable nature and the mountains. In conclusion, it was really good practice, very usefull and interesting. I improved my practical skills and theoretical background in neurology and clinical neurophysiology.
I want to thank EFNS for the possibility to visit Inselspital. Of course, special thanks go to Prof Bassetti, Prof Rosler, Prof Mathis, Prof Muri, Prof Schindler, Dr Ackermann, Dr Kalla, Dr Roth, Dr Zubler, Gabriela Horber, Claudia Wille and also for all residents with whom I examined patients not only not for professional communication, but also for their kindness and goodness.
Report from Dr Roberto Erro from Italy visiting the Clinical Neurophysiology Department at the National Hospital for Neurology and Neurosurgery, London, United Kingdom under the supervision of Dr Carla Cordivari.
I am pleased to submit the following report as to the department to department EFNS cooperation programme, which I carried out from 08/09/2014 to 07/11/2014 at the Clinical Neurophysiology Department at the National Hospital for Neurology and Neurosurgery in London (UK) under Dr Carla Cordivari’s supervision.
1) The purspose of the visit was to learn the basics of running a neurophysiological laboratory for the diagnosis and treatment of movement disorders, with a special focus on dystonia and related conditions.
2) Description of the work carried out during the visit: I had the chance to perform more than 200 EMG-guided injections with botulinum toxin injections for dystonia, and to perform/review more than 100 movement disorder analyses (using different techniques including polymyography, EEG-EMG multichannel recording for the back averaging, coherence analyses, and recording with accelerometers). Moreover, I attended many teaching lectures on the theoretical aspects of the neurophysiology in movement disorders.
3) Description of the main results obtained: I learned how to use the EMG guidance for the botulinum toxin injections for the most common types of focal dystonia. I learned the main applicability of the neurophsyiology for the differential diagnosis of movement disorders. I also collected some data for research purposes. The grant I was given partly covered the living allowence (housing/travel).
With Best Regards,
Dr Roberto Erro
Report from Dr Sharov Dmitry from Minsk, Belarus visiting the Department of Neurology at the 1st Faculty of Medicine, Charles University in Prague, Czech Republic under the supervision of Professor Dr Karel Šonka.
My practice was held at the Sleep and Wake Disorders Center, that is part of Neurological Clinic,1st Medical Faculty, Charles University in Prague. Principal diagnostic indications in the Centre: differential diagnosis of states involving excessive daytime sleepiness (narcolepsy, idiopathic hypersomnia, sleep apnoea, RLS, periodic leg movements disorder, etc.) and their therapeutic management; precise testing for sleep-related breathing disorders and their management; differential diagnosis of parasomnias (abnormal states in sleep: pavor nocturnus, nightmare, sleepwalking, epileptic seizure, REM sleep behaviour disorder etc.) and their management; differential diagnosis of insomnias and treatment for some of them; differential diagnosis of the causes of poor-quality nocturnal sleep and treatment for some of them; diagnosis of circadian rhythm sleep disorders and their management.
Polysomnography, limited polysomnography, basics of CPAP-therapy were studied by me during this period. I used Epworth Sleep Scale, Beck Depression Inventory, a lot of videos with different parasomnic conditions were reviewed by me. Very often I was at the primary patients receiving. I descripted several limited polysomnograms with the chief nurse. I studied the basics of applying CPAP machines, auto-CPAP and BiPAP devices.
Theoretical somnology basics were studied – the International classification of sleep disorders, 3rd edition. „Nuts and bolts” of polysomnography, clinical features and management of different sleep-wake disorders.
My usual day at Professor’s Šonka clinic started at 7.30 a.m. and continued until 5.00 p.m. At 7.30 a.m. we descripted limited polysomnograms together with the chief nurse of our department. Then I descripted polysomnograms by myself, that were controlled by Prof Šonka or other collegues after that. On Wednesdays from 8.00 until 12.00, I was with Prof Šonka in ambulance. Each Tuesday and Thursday we did visiting rounds of patients in the department and then medical histories of all of them were discussed. Each Tuesday at 8.00 we discussed difficult MRI and CT scans.
I participated in he 17th Czech and 11th Czech-Slovak Sleep Medicine Congress. It was held from 6th until 8th November in Prague. The main topic of this action was obesity and sleep apnoea. Most of all I liked the reports about sleep apnoea and driving and reports about new classifications of sleep disorders.
I visited several lectures for doctors and medical students in our clinic, such as „Focal Epilepsies“ and „REM-sleep and neurodegenerative diseases“. With Profr Šonka we started working on an article dedicated to idiopathic hypersomnia, because there are still many unclear aspects about this desease.
So, during my traineeship I studied: 1) Theoretical basis of sleep medicine. 2) „Nuts and bolts“ of polysomnography. 3) The basics of CPAP-therapy.
I‘m very glad to have participated in the D-D EFNS Programme. Especially I want to thank Professor K. Šonka and J. Buskova for their help and coaching my 6-weeks practice!
Report from Dr Marushchenko Myroslava from Ukraine visiting the Department of Neurology at the Christian Doppler Klinik, Universitätsklinikum der PMU, Salzburg, Austria under the supervision of Professor Dr Eugen Trinka.
According to the goals of the EFNS Department to Department Programme during the period from 17/03/2014 until 04/04/2014 I participated actively in the everyday activities of the Department of Neurology of Christian-Doppler-Klinik Paracelsus Medizinische Privatuniversität.
The programme activities included:
- Everyday participation in morning meetings of the doctors and residents of the Department of Neurology of Christian-Doppler-Klinik.
- Everyday working in a EMG doctor’s consulting room, the EEG-Videomonitoring Department, the Neurosonologic doctor’s consulting room and Stroke Unit Department.
- Listening to the morning referats on the problems of differential diagnostics of polyneuropathias and about features of using and mechanisms of influence of levodopa in treatment of parkinsonism.
- Participation in the conference of neurologists and neurosurgeons: “39 & 40 Interdisziplinare Patientenmanagementkonferenz – Seizure Conference”.
- Participation in the 11 Annual meeting of Austrian Society for Neurologists in Salzburg.
- Participation in the clinical duty at the Admission Department of the Department of Neurology.
- Participation in practical lessons of students of the PMU.
Report from Dr Elizaveta Rublevskaya from Belarus visiting the Neurology Department at the Bezirksklinikum, University of Regensburg, Germany under the supervision of Professor Dr Robert Weissert.
During my practice in the Neurology Department at the Bezirksklinikum of the University of Regensburg I took part in everyday activities in the out-patient and in-patient departments. Thus I had an opportunity to learn the structure of a Neurology Department, organisation of doctor’s work, current contemporary approaches to the diagnosis, management and treatment of different neurological disorders of central and peripheral nervous system, and diseases in adjacent specialties.
In the process of work with local neurologists I improved my practical skills in neurological examination of patients with different complaints, deepened my theoretical knowledge about neurological diseases, especially rare ones, about laboratory tests and instrumental methods of their diagnosis and approaches for their treatment.
I saw quite rare cases such as amyotrophic lateral sclerosis, stiff person syndrome, neuromyotonia (Isaacs’s syndrome), CADASIL syndrome, carotid artery dissection, neurological manifestation of Whipple’s disease.
I got acquainted with methodic of detailed neuropsychological testing, principles of interpretation of CT and MRI scans, routine procedures of electroneurography, electromyography, electroencephalography, transcranial magnetic stimulation.
To summarise, the participation in the Department to Department Programme gave me a unique opportunity to learn contemporary management of neurological diseases. Medical strategies in some neurological disorders in Belarus are quite different in comparison to what I learned here. The main reason is lack of possibilities of diagnostic procedures and new expensive medicines. Now I’m ready to try to implement my new knowledge in Belarussian health care system as diligently as I can.