The fellowship training program in Neuroimmunology at the Maryland Center for Multiple Sclerosis
The Maryland Center for MS, which was established 30 years ago, is recognized for the design and conduct of clinical trials in multiple sclerosis, comprehensive care of MS patients at all stages of their disease, and the conduct of basic science research to better understand the pathogenesis of MS. The Center cares for one-third of the MS population in the state of Maryland and approximately 1200 patient visits occur annually. Care is provided in a new ambulatory center at the University of Maryland and in an active MS day program located at an affiliated rehabilitation facility, Kernan Hospital. Comprehensive care is provided; this includes diagnostic and second opinion consultation for ambulatory of patients, hospitalization for seriously ill patients, and rehabilitative care. The clinical trials program has been very successful and the center is credited for playing a major role in the development of Betaseron and Glatiramer acetate for the treatment of MS. A number of industry sponsored clinical trials and peer-reviewed, MS-related grants from the NIH, the National Multiple Sclerosis Society, and the VA Research Service are active in order to specifically seek a better treatment and understanding of the pathogenesis of MS.
The program enables trainees to become independent investigators in the conduct of basic and clinical research in the broad field of MS. The fellowship consists of five interrelated components:
Practice and Care for MS Patients: Over the first three months of the fellowship, fellows undergo a period of initiation during which their role as a physician in the care of MS patients is reviewed by mentors. During this period fellows gain insight on how to inform new patients of the trials available to them and enrolling them on the basis of patients informed consent. Over the course of the fellowship, the fellow will be trained in the comprehensive evaluation and management of patients with classical forms of multiple sclerosis, MS variants (e.g., neuromyelitis optica), and clinically isolated syndromes. This includes experience in the management of relapses, progressive disease and MS-related symptoms and in identifying the appropriate choice of therapy for each disease stage.
Design and Conduct of Clinical Trials: The Maryland Center for MS is a premier site for the conduct of clinical trials involving the use of Interferons, Copaxone, Novantrone, combination therapies, rescue treatments, and novel therapeutic agents. The fellow is expected to participate actively in clinical trials that enroll patients in the early stages of their disease as well as those that enroll progressive patients. The fellow participates in these trials as an examining physician and gains experience in the use and interpretation of clinical outcome measures such as the EDSS score, the multiple sclerosis functional composite score, nine-hole peg test, paced auditory serial addition test (PASAT), and MRI outcome measures.
MRI-based training: Most clinical trials in MS have an MRI component as an outcome measure. A Neuroradiologist with special expertise in multiple sclerosis is responsible for the acquisition and analysis of the MRIs. A portion of the fellow's training time is devoted to the review of the MRIs connected with the trials. This provides the fellow with experience in using the MRI as a diagnostic tool as well as an outcome measure in the evaluation of therapeutic interventions in MS. In addition, experience and specific training opportunities are available for interested individuals in the areas of quantitative MRI analysis and in the applications and analysis of non-conventional MRI techniques (e,g,. MR spectroscopy, diffusion-weighted imaging, magnetization transfer MRI and functional MRI).
Formal course work in statistics, epidemiology and design of clinical trials: Understanding statistical principles as applied to biomedical investigation is an important component of the fellowship. The Department of Epidemiology and Preventive Medicine at the University of Maryland Medical Center offers a number of courses in epidemiology, biostatistics, and design and conduct of clinical trials. The fellow is expected to complete three such courses.
Conduct of basic research in Neuroimmunology: Fellows interested in basic research have the opportunity to work in conjunction with one of the faculty members who have funded research programs. Areas of training include cellular immunology, cell signaling, neurovirology, mechanisms of demyelination, mechanisms of MS therapies, and gene therapy. Fellows are expected to participate in weekly neuroimmunology seminars to review their research progress and to interact with other research groups in Immunology and Neuroscience. Formal course work in Immunology is available through the Department of Microbiology and Immunology.
Walter Royal, MD. Professor of Neurology and Director, Maryland Center for MS. Neurovirology and Neuroimmunology; Viral, Metabolic and Environmental Factors in MS Disease Pathogenesis; Immune Markers of MS Disease Activity
Christopher Bever, M.D., Professor of Neurology and Chief, VAMC Neurology Service. Role of macrophages in inflammatory demyelination. Application of Robotics in MS rehabilitation. Symptomatic therapy in MS. Experimental MS therapies.
Horea Rus, MD, PhD. Associate Professor of Neurology. Neuroimmunology of MS; Role of B cells and Genetic Markers of Disease Activity in MS
Robert K. Shin, MD, Associate Professor of Neurology and Ophthalmology. Neuro-ophthalmological Syndromes in MS; Experimental MS Therapies
David Trisler, Ph.D. Staff Scientist. Stem cells replacement therapy for neurological diseases.
Susan Judge, Ph.D. Assistant Professor of Neurology. Neurophysiology of potassium channels.
Tapas Makar, PhD. Assistant Professor. Neuroprotection in EAE.
The program is designed as a post-doctoral fellowship. Individuals with MD, PhD or MD/PhD are eligible. MD candidates may apply at any stage of their training following graduation from medical school, but preference will be given to applicants who are in or have completed a neurology residency program. The following documentation must be provided:
Correspondence should be sent to:
Dr. Walter Royal
Maryland Center for MS 110 S. Paca Street, 3rd floor
Baltimore, MD 21201
Appointments will be generally for a period of two years with the possibility of further extension. Fellows will begin on July 1 of each year, but other starting dates may be arranged. Stipend depends on the level of previous training and will be competitive with national standards.