DUKE CME: TRANSFORMING KNOWLEDGE
Duke University Health Systems and
The Division of Neurology
PRESENTS THE
11th Annual Advanced
EMG & EMG-Guided
Chemodenervation
Workshop
March 1-3, 2013
Duke University Medical Center
Durham, NC
Sponsored by the Duke University School of
Medicine
Program Description & Objectives
Advanced EMG & EMG-Guided Chemodenervation
Statement of Need
This course is designed to introduce practicing electromyographers and
those in training to advanced concepts and techniques in EMG, to
ultrasonography of peripheral nerve and muscle, and to the use of EMG
guidance in chemodenervation.
Target Audience
Neurologists and physiatrists in practice and in training,
electromyographers, neuromuscular specialists, clinical
neurophysiologists and movement disorder specialists.
Learning Objectives
At the conclusion of this activity, participants should be able to:
 Recall muscle anatomy and use EMG identification of muscles in
technically difficult areas, such as the neck, forearm, and face.
 Recognize the electromyographic patterns associated with dystonia.
 Recognize the differences in the currently available botulinum
toxins, their different dosing and sided effect profiles, and use in
movement disorders.
 Recall the concepts underlying generation of sensory and motor
nerve action potentials, motor unit action potentials, and the
interference pattern.
 Recall the principles of analysis of motor unit action potentials and
interference patterns.
 Identify signals acquired with concentric needle and single-fiber
electrodes, recognize artifacts and describe the significance of
abnormalities.
 Recognize the ultrasound characteristics of peripheral nerve.
Course Directors
Janice M. Massey, M.D., Professor of Medicine (Neurology),
Duke University Medical Center
Donald B. Sanders, M.D., Professor of Medicine (Neurology),
Duke University Medical Center
Vern C. Juel, M.D., Associate Professor of Medicine (Neurology),
Duke University Medical Center
March 1, 2013 – EMG-Guided
Chemodenervation
7:30 - Registration & Continental Breakfast
8:00 Welcome & Introduction
Janice M. Massey, M.D.
8:10 Dystonia Overview
Zaeem Siddiqi, M.D. Ph.D.
8:40 Botulinum Toxin Overview
Pharmacology & General Principles of Use
Janice M. Massey, M.D.
9:00 EMG Changes after Botulinum Toxin
Janice M. Massey, M.D.
9:20 EMG-Guided Chemodenervation
Principles & Procedures in Cervical & Limb Dystonia
Vern C. Juel, M.D.
10:00 Coffee & Discussion
(Billing, Coding, & Supply Information at Table)
10:15 Spasticity in Pediatric Patients
Edward C. Smith, M.D.
10:50 Spasmodic Dysphonia (Video)
David L. Witsell, M.D., M.H.S.
11:10 Muscle Anatomy: Video Demonstrations & Discussion
Faculty
12:15 Lunch (provided)
1:00 Rotating Rooms/Live Demonstrations:
Chemodenervation for Cervical Dystonia, Spasticity, Facial and Limb
Dystonia
5:00 Summary
5:30 Adjourn
March 2, 2013 – Advanced EMG
7:30 Registration & Continental Breakfast
8:00 Welcome & Introduction
Donald B. Sanders, M.D.
8:10 Introduction to SFEMG
Donald B. Sanders, M.D.
8:45 Concentric Needle Jitter Studies
Erik Stålberg, M.D.
9:30 The Motor Unit and Quantitative EMG
Erik Stålberg, M.D.
10:15 Coffee & discussion
10:45 Motor Unit Number Estimates
Clifton L. Gooch, M.D.
11:30 Ultrasonography of Peripheral Nerve & Muscle
Francis Walker, M.D /Lisa Hobson-Webb, M.D.
12:15 Lunch (provided) & Discussion
12:45 Rotating Rooms/Small Group Demonstrations
Ultrasound, RNS, Stimulated SF, Voluntary SF, Jitter with Concentric
Needle Electrodes, MUNE, QEMG
5:30 Summary/Discussion
5:45
March 3, 2013 – Advanced EMG
7:30 Continental Breakfast
8:00 Neurography: Introduction and Update
Late Responses: A through T
Erik Stålberg, M.D.
9:00 Mononeuropathies: Clinical Presentation and Anatomy
E. Wayne Massey, M.D.
9:30 Ultrasonography of Peripheral Nerve in the EMG Lab
Francis O. Walker, M.D./Lisa Hobson-Webb, M.D.
10:00 Coffee & Discussion
10:15 Clinical Application of Jitter Studies
Donald B. Sanders, M.D.
10:45 Exercise Testing in Channelopathies
Jeffrey T. Guptill, M.D.
11:15 Case Presentations & Discussion (with Coffee)
Duke Neuromuscular Fellows
12:45 Review & Questions/Discussion
1:00 Close
Accreditation/Credit Designation
The Duke University School of Medicine is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to
provide continuing medical education for physicians.
The Duke University School of Medicine designates this educational
activity for a maximum of 21.5 AMA PRA Category 1 Credit(s) .
Physicians should only claim credit commensurate with the extent of
their participation in the activity.
TM
Disclaimer
The information provided at this CME activity is for continuing education purposes only and is
not meant to substitute for the independent medical judgment of a healthcare provider relative to
diagnostic and treatment options of a specific patient’s medical condition.
Commercial Support Acknowledgement
This CME activity is supported by educational grants. A complete list of supporters will be
published in the course syllabus.
Disclosure
The Duke University School of Medicine adheres to ACCME Essential Areas, Standards, and
Policies regarding industry support of continuing medical education. Disclosure of the planning
committee and faculty’s commercial relationships will be made known at the activity. Speakers
are required to openly disclose any limitations of data and/or any discussion of any off-label,
experimental, or investigational uses of drugs or devices in their presentations.
Resolution of Conflicts of Interest
In accordance with the ACCME Standards for Commercial Support of CME, the Duke
University School of Medicine will implement mechanisms, prior to the planning and
implementation of this CME activity, to identify and resolve conflicts of interest for all
individuals in a position to control content of this CME activity.
Additional Information
Contact:
Angela Cope
Duke University Medical Center & Health Systems
DUMC 3403
Durham, NC 27710
Phone: 919-684-5422
Fax: 919-660-3853
Angela.Cope@duke.edu
Meeting Location
Barrus Conference Room 3031
Duke South Clinic 1L
Duke University Medical Center
Durham, NC 27710
Electromyography Laboratory
Duke South Clinic 1L
Duke University Medical Center
Durham, NC 27710
Parking is available at the DUMC parking garage located on Trent
Drive in front of Duke Clinic.
Registration Information
Space is limited. Early registration is encouraged.
th
11 Annual Advanced EMG & EMG-Guided
Chemodenervation Workshop
March 1-3, 2013
Online registration is available (accept Visa and MasterCard payment).
Please visit – http://cmetracker.net/DUKE/Courses.html
Telephone registrations can not be accepted.
REGISTRATION FEE:
Your registration fee covers: Tuition, continental breakfasts, lunches, breaks, and the syllabus.
Friday, March 1
• Cost: $375.00 (8.25 CME credits for Friday only attendance)
Saturday, March 2 – Sunday, March 3
• Cost: $375.00 (13.25 CME credits for Sat & Sun only attendance)
Both the Friday and Saturday/Sunday sessions
• Cost: $650.00 (21.5 CME credits for Fri, Sat & Sun attendance)
A limited number of registration fellowships are available for trainees. Requests should be
accompanied by documentation of training status. For more information, contact
Angela.Cope@duke.edu For on-line registration questions, please contact the Duke CME
Office at huang013@mc.duke.edu or call (919) 401-1204
Special Needs Statement
The Duke Department of Medicine is committed to making its activities
accessible to all individuals. If you are in need of a special
accommodation, please do not hesitate to call and/or submit a
description of your needs in writing in order to receive service.
Guest Faculty
Erik Stålberg, M.D., Ph.D., Professor Emeritus, Clinical
Neurophysiology, Uppsala University Hospital, Uppsala, Sweden
Clifton L. Gooch, M.D., Professor & Chairman, Department of
Neurology, University of South Florida, Tampa, FL
James F. Howard, M.D., Distinguished Professor of Neurology,
Chief, Neuromuscular Diseases Section, University of North Carolina at
Chapel Hill, NC
Zaeem Siddiqi, M.D., Ph.D., Associate Professor of Neurology,
University of Alberta, Canada
Francis O. Walker, M.D., Professor of Neurology,
Wake Forest University, Winston-Salem, NC
Duke University Medical Center
Faculty & Staff
Janice M. Massey, M.D., Professor of Medicine (Neurology),
Director, Neuromuscular Service & Electromyography Laboratory
Donald B. Sanders, M.D., Professor of Medicine (Neurology)
Vern C. Juel, M.D., Associate Professor of Medicine (Neurology)
Lisa Hobson-Webb, M.D., Assistant Professor of Medicine
(Neurology)
Edward C. Smith, M.D., Assistant Professor of Pediatrics (Neurology)
E. Wayne Massey, M.D. Professor of Medicine (Neurology)
Jeffrey T. Guptill, M.D. Instructor in Medicine (Neurology)
David L. Witsell, M.D., M.H.S., Associate Professor of Surgery
(Otolaryngology – Head & Neck Surgery)
Coordinator: Angela Cope
Technical Assistance: Kevin Morley