Clinical Fellowship Reports 2019

Fellow: Nicolas Jean Dubuisson, Belgium

Term of the Fellowship: March – September 2019

Hosting department: Department of Neurology and Neurosurgery, Neuromuscular Disorders, University Medical Center (UMC) Utrecht, The Netherlands

Supervisor: Dr. H.S. Goedee, PhD

These 6 weeks in Utrecht were an amazing opportunity for me to learn from well-known experts in Neuromuscular diseases such as Dr. Goedee and other consultants from the UMC neurology department.

This experience has dramatically improved my knowledge in how to manage patients with demyelinating neuropathies in its entirety, from the diagnosis to the treatment, without forgetting the human and social dimensions.  I also had the opportunity to attend high quality teaching sessions, especially in plexus MRI and nerve biopsies.

I also gained great experience in the technical skills necessary to perform nerve sonography.

The neuromuscular department of Utrecht Medical Center is a reference center for inflammatory neuropathies. As a result, patients from all parts of the Netherlands are referred to them in order to benefit from their expertise. This environment and the amount of patient eligible for nerve sonography allowed me to practice sonography daily and perform approximately 20 assessments per week.

The sonography teaching provided by Dr. Goedee was done in three consecutive steps:

1. Learn how to use probe and ultrasound machine correctly, recognize anatomical landmarks.
2. Perform nerve sonography and compare results directly in consecutive patients with direct supervision of Dr. Goedee. This part of the training further helped to shorten learning curve, and improved the live practice.
3. Independently obtain complete sonography assessments during clinical routine as well as interpreted the result in order to support clinical diagnosis.

My objective for the future, is to continue to practice nerve sonography in Belgium, and finally to implement this technique in our clinical routine. The first step has been done, since our neuromuscular center bought a sonography machine, which will be delivered soon.

With the support and help of Dr. Goedee, we are currently collaborating on a paper in order to establish cut-off values for brachial plexus measurement in demyelinating neuropathies.

In addition, we planned to publish a case series reporting sonographic characteristics of patients suffering from combined cerebral and peripheral demyelinating disorder (CCPD). Dr. Goedee and myself aim to continue our collaboration beyond the EAN internship and establish close link between Utrecht Medical Center and UCL St-Luc neuromuscular centers.

First I would like to thank the European Academy of Neurology for this great opportunity. This was a memorable experience. My visit to Nuovo Ospedale Civile “S.Agostino-Estense”, University Hospital of Modena was fruitful. During my visit to the stroke unit I was able to have a very close look to the collaboration between the stroke team members and the amazing protocol of acute stroke management starting from the ER evaluation, passing through the recanalization procedures either by thrombectomy or thrombolysis, ending by secondary prevention, rehabilitation and follow up. It is the best protocol to be adapted and applied in my home country.

I really admired how everyone‘s efforts are directed towards providing the best patient care. I was included in the scientific activities such as weekly staff meetings where challenging cases were discussed. Every Tuesday, there was a vascular group meeting. It was great for me to listen to the discussions. I would Like to thank Prof Dr Stefano Meletti the head of the department for his hospitality and support.  I am really grateful to Dr Guido Bigliardi for everything. He was extremely supportive, caring and too open for any questions. This visit added a lot of experience and scientific knowledge in the field of cerebrovascular diseases and paved my way for better decision making.