NEUROMUSCULAR

Neuroscience and Spine Institute has a unique strength in treating neuromuscular disorders including Amyotropic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, and is home to The Carolinas Neuromuscular/ALS-MDA Center, the Southeast's most comprehensive facility for the study and treatment of degenerative neuromuscular diseases. A multi-disciplinary team of specialists provides aggressive, proactive treatment plans, integrating research with patient care to find new solutions for the devastating neuromuscular disorders of ALS, multiple sclerosis, epilepsy and Parkinson's disease.

Carolinas Neuromuscular Program
The Carolinas Neuromuscular Program at Carolinas Medical Center is built around a model of comprehensive diagnostic and treatment services. The program supports specialty clinics dedicated to the treatment of a specific disease and general neuromuscular clinics serving both adult and pediatric patients. It also integrates the services of many subspecialists, each with a dedicated interest in treating neuromuscular disease. Constant improvements in diagnosis and treatment make such a comprehensive approach necessary.

The Staff
The staff of the Carolinas Neuromuscular Program includes multiple specialists, most with formal training in neuromuscular disease. These specialists form a team that regularly participates in all patient evaluations.

The practitioners in the group meet regularly to coordinate their efforts and discuss diagnostic and treatment options. The staff maintains regular contact with referring physicians and allied health personnel. Patients may be treated at Carolinas Medical Center or in a facility closer to their homes.

The Services
Genetics
Advances in molecular biology have dramatically changed diagnostic approaches to neuromuscular disease. The Carolinas Neuromuscular Program has the ability to test for many genetic diseases using both commercially available technology and by collaboration with other experimental laboratories. A genetic counselor is available for education and counseling prior to testing and following diagnosis.

Patient Education
The Carolinas Neuromuscular Program offers many forms of patient education. It also maintains a close liaison with the Muscular Dystrophy Association, which provides a large volume of patient education materials. In addition, the program offers access to area support groups and national organizations for many disorders.

Biopsy
Muscle and nerve biopsies are periodically needed to assist in a neuromuscular diagnosis. The Carolinas Neuromuscular Program and Carolinas Medical Center maintain a comprehensive pathology laboratory for evaluating biopsy specimens. They are also active in a national network of other leading neuromuscular centers whose qualified experts collaborate on complex or unusual diagnoses.

Muscular Dystrophy Association
The Muscular Dystrophy Association (MDA) sponsors clinics on a weekly basis. These clinics take an interdisciplinary team approach toward initial diagnosis and follow-up care for both children and adults. The MDA regularly refers patients who might have a neuromuscular disease to the Carolinas Neuromuscular Program for evaluation. The patient's primary care physician often collaborates treatment efforts with the team after the evaluation. The MDA also provides assistance for patients who need help financing the services and equipment necessary to maintain an optimal quality of life.

Amyotrophic Lateral Sclerosis
The Carolinas ALS Center is part of the Carolinas Neuromuscular Program. Patients who may have amyotrophic lateral sclerosis (ALS) are evaluated by the ALS study team over a two-day period. At least 10 practitioners evaluate each patient in order to obtain a base-line assessment. An integrated treatment plan is implemented at the initial evaluation, often by providing the therapy and/or the equipment required.

The Team
The cooperation of many contributing specialists is an essential part of the Carolinas Neuromuscular Program's comprehensive approach to diagnosing and treating neuromuscular disease. Each of the specialists who regularly evaluate patients has a commitment to and specialized training in neuromuscular diseases. Total patient care is a high priority for the team members, and regular meetings are held to facilitate communication among specialists. Currently, the team includes members from the following specialties:

	Neurology
	Pediatric neurology
	Pulmonology
	Orthopaedics
	Gastroenterology
	Nutrition
	Physiatry
	Neuromuscular pathology
	Genetics
	Respiratory therapy
	Orthotics
	Social work
	Equipment specialists
	Occupational therapy
	Physical therapy
	Neuromuscular nursing

Patients seen in the ALS clinics benefit from an evaluation by all ALS team members on every visit, they come every month.

Clinical Trials
Participation in national and local clinical trials is a high priority within the Carolinas Neuromuscular Program. Patients are regularly made aware of research opportunities for new trials exploring alternative medications as well as treatments.

The Clinics
A variety of specialty clinics are available to patients with specific problems:

	General Neuromuscular Clinic
	MDA Clinic
	Pediatric MDA Clinic
	ALS Team Evaluation (new patients)
	Multidisciplinary ALS Follow-up
	Electrodiagnostic Laboratory

To schedule a visit to a specialty clinic, call the Carolinas Neuromuscular Program at 704-446-6257 or 800-924-7620. Relevant patient records may be faxed to 704-446-6255.

Neuromuscular Diseases

	Muscular Dystrophies
	Duchenne (pseudohypertropic) muscular dystrophy
	Becker muscular dystrophy
	Emery-Dreifuss muscular dystrophy
	Limb-girdle muscular dystrophy
	Facioscapulohumeral (Landouzy-Dejerine) muscular dystrophy
	Myotonic dystrophy (Steinert's disease)
	Oculopharyngeal muscular dystrophy
	Distal muscular dystrophy
	Congenital muscular dystrophy

Motor Neuron Diseases:

	Amotrophic lateral sclerosis (ALS)
	Infantile progressive spinal muscular atrophy (Type 1, Werdnig-Hoffman disease)
	Intermediate spinal muscular atrophy (Type 2)
	Juvenile spinal muscular atrophy (Type 3, Kugelberg-Welander disease)
	Juvenile spinal muscular atrophy (Type 3, Kugelberg-Welander disease)
	Adult spinal muscular atrophy (Aran-Duchenne type)

Inflammatory Myopathies

	Polymyositis
	Dermatomyositis

Diseases of Neuromuscular Junction

	Myasthenia gravis
	Lambert-Eaton (myasthenic) syndrome

Diseases of Peripheral Nerves

	Charcot-Marie-Tooth disease (peroneal muscular atrophy)
	Friedreich's ataxia
	Dejerine-Soltas disease

Metabolic Diseases of Muscle

	Phosphorylase deficiency (McArdle's disease)
	Acid maltase deficiency (Pompe's disease)
	Phophofructokinase deficiency (Tarui's disease)
	Debrancher enyzme deficiency (Cori's or Forbes' disease)
	Mitochondrial myopathy
	Carnitine deficiency
	Carnitine palmityl transferase deficiency
	Phosphoglycerate kinase deficiency
	Phosphoglycerate mutase deficiency
	Lactate dehydrogenase deficiency
	Myoadenylate deaminase deficiency

Myopathies Due To Endocrine Abnormalities

	Hyperthyroid myopathy
	Hypothyroid myopathy

Other Myopathies

	Myotonia congenita
	Paramyotonia congenita
	Central core disease
	Nemaline myopathy
	Myotubular myopathy
	Periodic paralysis