DM Neurology: Admissions, Medical Colleges, fees, eligibility criteria details

SYLLABUS

Course contents

AIM:

To produce specialists with necessary skills, judgement and sense of dedication to tackle all major and minor cardiac problems. The candidates will be trained in all aspects of Neurology starting from Basic Sciences to recent advances.

PAPER I: BASIC SCIENCES RELATED TO NEUROLOGY

NEUROANATOMY

The Neuroanatomy with special emphasis on development of:

· Neuroaxis (brain, spinal cord and neurons and glia),

· Autonomic nervous system and their maturation process in the post-natal, childhood and adolescent states;

· Location and significance of stem cells,

· CSF pathways,

· Blood supply and sino venous drainage of brain and spinal cord, the meninges,

· Skull and vertebral column, the cranial nerves, spinal roots, plexuses, and their relation to neighboring structures;

· Anatomy of peripheral nerves,

· Neuromuscular junction and muscles;

· Histology of cerebrum, cerebellum, pituitary gland, brain stem and

spinal cord, nerves and neuromuscular junction and muscle.

· Functional anatomy of lobes of cerebrum and white matter tracts of brain and spinal cord, craniovertebral junction, conus and epiconus and cauda equina, brachial and lumbosacral plexuses, cavernous and other venous sinuses;

· New developments in understanding of:

o Ultrastructural anatomy of neurons,

o axonal transport,

o neural networks and synapses and nerve cell function at molecular level.

NEUROPHYSIOLOGY

• Neurophysiology will cover all the physiological changes in the nervous system during its normal function with special reference to nerve impulse transmission along myelinated fibers,
• neuromuscular junction and synaptic transmission,

· muscle contraction;

· visual, auditory and somatosensory and cognitive evoked potentials;

· Regulation of secretions by glands, neural control of viscera such as heart, respiration, GI tract, bladder and sexual function; sleep-wake cycles;

· Maintenance of consciousness,

· special senses,

· control of functions of (a) pituitary, (b) autonomic system (c) cerebellum, (d) and extrapyramidal functions,

· reflexes,

· upper and lower motor neuron concepts and sensory system.

MOLECULAR BIOLOGY

Brain is the one structure where maximum genes are expressed in the human

body. The topics include:

· Principles of molecular biology including Gene Structure, Expression and regulation;

· Recombinant DNA Technology;

· PCR Techniques,

· Molecular basis for neuronal and glial function,

· Molecular and cellular biology of the membranes and ion-channels,

· Mitochondrial genome,

· Role of RNA in normal neuronal growth and functional expression,

· Receptors of neurotransmitters,

· Molecular and cellular biology of muscles and neuromuscular junction, etc.

· The Human Genome and its future implications for Neurology including

developmental and neurogenetic disorders,

· bioethical implications and genetic counselling,

· Nerve growth and other trophic factors and neuroprotectors,

· Neural Tissue modification by genetic approaches including Gene Transfer, stem cell therapy etc.

· Molecular Development of neural tissue in peripheral nerve repair

NEUROCHEMISTRY

· All aspects of normal and abnormal patterns of neurochemistry including:

· Neurotransmitters associated with different anatomical and functional areas of brain and spinal cord, especially with respect to dopaminergic, serotoninergic, adrenergic and cholinergic systems,

· Opioids,

· Excitatory and inhibitory amino acids and their role in pathogenesis of Parkinsonism, depression, migraine, dementia, epilepsy,

· Neuromuscular junction and muscle contractions,

· Carbohydrate, amino acid and lipid metabolism,

· Neural expression of disorders of their metabolism,

· Electrolytes and their effect on encephalopathies,

· Muscle membrane function, storage disorders,

· Porphyria.

NEUROPHARMACOLOGY

• Application of neuropharmacology in medical therapy of epilepsy, Parkinsonism, movement disorders, neuropsychiatric syndromes, spasticity, pain syndromes, disorders of sleep and dysautonomia syndromes.
• Antiepileptic drugs, usage during disorders of renal, hepatic function and in dementia.
• Adverse drug reactions of common drugs used in Neurological disorders including antiepileptic drugs, antiplatelets, anticoagulants etc.

NEUROPATHOLOGY

• Pathological changes in various neurological diseases with special reference to vascular, immune-mediated, demyelinating and dysmyelinating, metabolic and nutritional, genetic and developmental, infectious and iatrogenic and neoplastic etiologies and clinical correlation.
• Pathological changes in nerve and muscle in neuropathies and myopathies.
• Ultrastructural pathology such as apoptosis, ubiquitinopathies, mitochondrial diseases, channelopathies, peroxisomal disorders, inclusion bodies, prion diseases, disorders mediated by antibodies against various cell and nuclear components, paraneoplastic disorders etc.

NEUROMICROBIOLOGY

Microbiological aspects of infectious neurologic diseases including:

• Encephalitis, meningitis, brain abscess, granulomas, myelitis, cold abscess, cerebral malaria, parasitic cysts of nervous system, rhino cerebral mycoses, leprous neuritis, neuro leptospirosis, primary and secondary Neuro HIV infections, congenital TORCH infections of brain, slow virus infections such as CJD and SSPE.
• Neurological complications of viral infections such as Polio, EBV, Chickenpox, Rabies, Herpes, Japanese encephalitis and other epidemic viral infections.

NEUROTOXICOLOGY

Diagnosis and effective therapy of:

· Organophosphorus poisoning,

· hydrocarbon poisoning,

· lead, arsenic, botulinum toxin and tetanus toxicity,

· snake, scorpion, spider, wasp and beestings.

NEUROGENETICS AND PROTEOMICS:

· Autosomal dominant and recessive and X-linked inheritance patterns,

· disorders of chromosomal anomalies,

· Gene mutations, trinucleotide repeats, dysregulation of gene expressions,

· Enzyme deficiency syndromes,

· Storage disorders,

· Disorders of polygenic inheritance,

· Proteomics in health and disease.

NEUROEPIDEMIOLOGY:

• Basic methodology in community and hospital based neuro-epidemiological studies such as systematic data collection, analysis, derivation of logical conclusions,

· Concepts of case-control and cohort studies, correlations,

· Regressions and survival analysis,

· Basic principles of clinical trials.

PAPER II: CLINICAL NEUROLOGY INCLUDING PEDIATRIC NEUROLOGY and NEUROPSYCHIATRY.

GENERAL EVALUATION OF THE PATIENT

• The science and art of history taking,
• Physical examination including elements of accurate history taking, symptoms associated with neurological disease,
• Physical examination of adults, children, infants and neonates, syndromes

associated with congenital and acquired neurological disease, cutaneous

markers,

· Examination of unconscious patients,

· Examination of higher mental functions, cranial nerves, the ocular fundus,

· Examination of tone, power of muscles,

· Proper elicitation of superficial and deep reflexes including alternate techniques,

· Neonatal and released reflexes,

• Neurodevelopmental assessment of children, sensory system, peripheral nerves, signs of Meningeal irritation, skull and spine examination including measurement of head circumference, shortness of neck and carotid pulsations .and vertebral bruits.

DISTURBANCES OF SENSORIUM

• Pathophysiology and diagnosis of COMA,
• Diagnosis and management of coma, delirium and acute confusional states, reversible and irreversible causes,
• Persistent vegetative states and brain death,
• Neurophysiological evaluation and confirmation of these states,
• Mechanical ventilation and other supportive measures of comatose patient,
• Prevention of complications of prolonged coma,

· The significance of timely brain death in organ donation and ICU resource utilization.

SEIZURES and EPILEPSY and SYNCOPE

· Diagnosis of seizures, epilepsy and epileptic syndromes,

• Recognition, clinical assessment and management of seizures especially their electrodiagnosis, video monitoring with emphasize on phenomenology and their correlation with EEG,
• Structural and functional brain imaging such as CT and MRI and fMRI and SPECT scan, 
• Special situations such as epilepsy in pregnant and nursing mothers, driving, risky occupations, its social stigmas differentiation from pseudo seizures,

• Use of conventional and newer antiepileptic drugs, their drug interactions and adverse effects etc.,
• Modern lines of management of intractable epilepsies, such as ketogenic diet, vagal nerve stimulation, epilepsy surgery,
• Pre-surgical evaluation of patients,
• Management of status epilepticus and refractory status epilepticus,
• Differentiation of seizures from syncope, drop attacks, cataplexy, startles etc.

HEADACHES and OTHER CRANIAL NEURALGIAS

· Acquisition of skills in the analysis of headaches of various causes such as those from raised intracranial pressures, migraines, cranial neuralgias, vascular malformations,

· Meningeal irritation, Psychogenic etc. and their proper pharmacologic management.

CEREBROVASCULAR DISEASES

· Vascular anatomy of the brain and spinal cord,

• Various causes and types of cerebrovascular syndromes, ischemic and hemorrhagic types, arterial and venous types, anterior and posterior circulation strokes,

· OCSP and TOAST classifications,

· Investigation of strokes including neuroimaging using Dopplers,

• CT and MR imaging and angiography, acute stroke therapy including

thrombolytic therapy,

· Interventional therapy of cerebrovascular diseases,

· Principles of management of subarachnoid haemorrhage etc.

• Special situations like strokes in the young, strategies for primary and secondary prevention of stroke.

DEMENTIAS

· Concept of minimal cognitive impairment,

• Reversible and irreversible dementias causes such as Alzheimer’s and other neurodegenerative diseases and vascular and nutritional and infectious dementias, their impact on individuals, families and in society.
• Genetic and familial syndromes.
• Pharmacotherapy of dementias, the potential role of cognitive rehabilitation and special care of the disabled.

PARKINSONISM AND MOVEMENT DISORDERS

· Disorders of the extrapyramidal system such as Parkinsonism, chorea, dystonia, athetosis, tics, their diagnosis and management,

· Pharmacotherapy of Parkinsonism and its complications,

• management of complications of Parkinsonism therapy, including principles of deep brain stimulation and lesion surgeries.

· Use of EMG-guided botulinum toxin therapy,

· Management of spasticity using intrathecal baclofen and TENS.

ATAXIC SYNDROMES:

· Para infectious demyelination, cerebellar tumours, hereditary ataxias, vestibular disorders,

· Diagnosis and management of brainstem disorders,

· Axial and extra-axial differentiation.

CRANIAL NEUROPATHIES:

• Disorders of smell, vision, visual pathways, pupillary pathways and reflexes,
• Internuclear and supranuclear ophthalmoplegia,
• Other oculomotor disorders,
• Trigeminal nerve testing,
• Bell’s palsy,
• Differentiation from UMN facial lesions,
• Brain stem reflexes,
• Investigations of vertigo and dizziness,
• Differentiation between central and peripheral vertigo,

· Differential diagnosis of nystagmus,

· Investigations of deafness, bulbar and pseudobulbar syndromes.

CNS INFECTIONS:

• Diagnosis and management of viral encephalitides, meningitis bacterial, tuberculous, fungal, parasitic infections such as cysticercosis, cerebral malaria, SSPE, Neuro HIV primary and secondary infections with exposure to gram stain and cultures, bac tec, QBC, ELISA and PCR technologies.

NEUROIMMUNOLOGY DISEASES

• Diagnosis and management of CNS conditions such as Multiple Sclerosis, PNS conditions such as GBS, CIDP, Myasthenia gravis, polymyositis.

NEUROGENETIC DISORDERS

· Various chromosomal diseases,

• Single gene mutations such as enzyme deficiencies,
• Autosomal dominant and recessive conditions and X-linked disorders,

trinucleotide repeats,

• Disorders of DNA repair. Genetics of Huntington’s disease, familial dementias, other storage disorders, hereditary ataxias,
• Hereditary spastic paraplegias, HMSN, muscular dystrophies, mitochondrial inheritance disorders.

DEVELOPMENTAL DISORDERS OF NERVOUS SYSTEM

· Neuronal migration disorders,

· Craniovertebral junction diseases,

· Spinal dysraphism,

• Phacomatoses and other neurocutaneous syndromes- their recognition and management.

MYELOPATHIES

• Clinical diagnosis of distinction between compressive and non-compressive myelopathies,

· Spinal syndromes such as anterior cord, subacute combined degeneration,

· Central cord syndrome,

· Brown-Sequard syndrome,

· Tabetic syndrome,

· Ellsberg phenomenon.

· Diagnosis of spinal cord and root compression syndromes,

· CV junction lesions,

· Syringomyelia, conus cauda lesions,

· Spinal AVMs,

· tropical and hereditary spastic paraplegias,

· Fluorosis.

PERIPHERAL NEUROPATHIES

• Immune mediated, hereditary, toxic, nutritional and infectious type peripheral neuropathies; their clinical and electrophysiological diagnosis.

MYOPATHIES AND NEUROMUSCULAR JUNCTION DISORDERS

· Clinical evaluation of patients with known or suspected muscle diseases aided by EMG,

• Muscle pathology, histochemistry, immunopathology and genetic studies,
• Dystrophies, polymyositis, channnelopathies, congenital and mitochondrial myopathies,

· Neuromuscular junction disorders such as myasthenia, botulism, Eaton-lambert syndrome,

• Snake and organophosphorus poisoning, their electrophysiological diagnosis and management.

· Myotonia, stiff person syndrome.

PAEDITRIC NEUROLOGY:

· Normal development of motor and mental milestones in a child, Cerebral palsy,

· Attention deficit disorder,

· Autism,

· Developmental dyslexia,

· Intrauterine TORCH infections,

· Storage disorders,

· Inborn errors of metabolism affecting nervous system,

· Developmental malformations,

· Child hood seizures and epilepsies,

· Neurodegenerative diseases.

COGNITIVE NEUROLOGY AND NEUROPSYCHIATRY:

· Detailed techniques of higher mental functions evaluation,

• Basics of primary and secondary neuropsychiatric conditions such as anxiety, depression, schizophrenia, acute psychosis, acute confusional reactions (delirium), organic brain syndrome,

· Primary and secondary dementias, differentiation from pseudodementia.

TROPICAL NEUROLOGY

Conditions which are specifically found in the tropics like to be taught in detail;

· Neuro-cysticercosis,

· Cerebral malaria,

· Tropical spastic paraplegia,

· Snake/scorpion/ Chandipura

· Encephalitis,

· Madras Motor Neuron disease etc.

PAPER III: DIAGNOSTIC and INTERVENTIONAL NEUROLOGY INCLUDING NEUROLOGICAL INSTRUMENTATION, DIAGNOSTIC

NEUROLOGY

· Performing and interpreting Digital Electroneurogram, Electromyogram,

· Evoked potentials, Electroencephalography,

· Interpretation of skull and spine X-rays,

· Computerized tomography of brain and spine,

• Magnetic resonance images of brain including correct identification of various sequences, angiograms, MR spectroscopy,

· Basics of functional MRI,

• Interpretation of digital subtraction imaging, SPECT scans of brain, subdural EEG recording, transphenoidal electrode EEG techniques for temporal lobe seizures,
• video EEG interpretation of phenomenology and EEG-phenomenology correlations,
• EEG telemetry,
• Transcranial Doppler diagnosis and monitoring of acute ischemic stroke,
• Subarachnoid haemorrhage,
• Detection of right-to-left shunts etc;
• Colour duplex scanning in Carotid and vertebral extracranial segment screening.

NEUROINSTRUMENTATIONS

Acquire skills in procedures like:

· Intrathecal administration of antispasticity drugs, beta interferons in demyelination, opiates in intractable pain etc.,

· EMG-guided Botox therapy for dystonia,

· Subcutaneous administration of antimigraine and antiparkinsonian drugs,

• Intraarterial thrombolysis in extended windows of thrombolysis in ischemic strokes,
• Transcranial Ultrasound clot-bust intervention in a registry in acute stroke care unit,
• Planning in deep brain stimulation therapy in uncontrolled dyskinesias and on-off phenomena in long standing Parkinsonism,

· Planning in vagal nerve stimulation in intractable epilepsy.

PAPER IV:

RECENT ADVANCES IN NEUROLOGY:

ADVANCES IN NEUROIMAGING TECHNIQUES, BIONICS IN NEURAL PROSTHESIS and REHABILITATION, NEUROPROTEOMICS and NEUROGENETICS, STEM CELL and GENE THERAPY

ADVANCES IN NEUROIMAGING TECHNIQUES:

· Integration of CT, MR, SPECT, and PET images with each other and with EEG.

• EVOKED potentials-based brain maps in structural and functional localization in neurological phenomena and diseases.
• DSA interpretation and diagnosis.

BIONICS IN NEURAL PROSTHESIS AND REHABILITATION:

· Advanced techniques in neuro-rehabilitation such as TENS, principles of man-machine interphase devices in cord, nerve and plexus injuries, cochlear implants, artificial vision.

NEUROPROTEOMICS AND NEUROGENETICS:

Brain functions are regulated by proteomics and genomics linked to various proteins and genes relevant to the brain, the body’s maximum number of proteins and genes being expressed in brain as neurotransmitters or channel proteins and predisposing the brain to a number of disorders of abnormal functioning of these proteins.

STEM CELL AND GENE THERAPY:

· Principles of ongoing experiments on stem cell therapy for nervous system disorders such as foetal brain tissue transplants in parkinsonism; intrathecal marrow transplants in MND,MS, and Spinal trauma; myoblasts infusion therapy in dystrophies.

NEUROEPIDEMIOLOGICAL STUDIES AND CLINICAL TRIALS:

The students of the DM course will be trained in conducting sound Neuro-epidemiology studies on regionally and nationally important neurological conditions as well as on diseases of scientific and research interest to the department. They will also be trained in the principles of clinical trials.

Essential Practical Knowledge

Career Options

After completing a DM in Neurology, candidates will get employment opportunities in Government and the Private sector.

In the Government sector, candidates have various options to choose from which include Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector, the options include Resident Doctor, Consultant, Visiting Consultant (Neurology), Junior Consultant, Senior Consultant (Neurology), and Neurology Specialist.

Courses After DM in Neurology Course

DM in Neurology is a specialization course that can be pursued after finishing a Postgraduate medical course. After pursuing a specialization in DM in Neurology, a candidate could also pursue certificate courses and Fellowship programmes recognized by NMC and NBE, where DM in Neurology is a feeder qualification.

Frequently Asked Questions (FAQs) –DM in Neurology Course

• Question: What is the full form of DM?

Answer: The full form of DM is a Doctorate of Medicine.

• Question: What is a DM in Neurology?

Answer: DM Neurology or Doctorate of Medicine in Neurology also known as DM in Neurology is a super specialty level course for doctors in India that they do after completion of their postgraduate medical degree course.

• Question: What is the duration of a DM in Neurology?

Answer: DM in Neurology is a super speciality programme of three years.

• Question: What is the eligibility of a DM in Neurology?

Answer: The candidate must have a postgraduate medical Degree in MD/DNB (General Medicine) or MD/DNB (Paediatrics) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the scope of a DM in Neurology?

Answer: DM in Neurology offers candidates various employment opportunities and career prospects.

• Question: What is the average salary for a DM in Neurology candidate?

Answer: The DM in Neurology candidate's average salary is between Rs. 30 lakhs to Rs. 60 lakhs per year depending on the experience.

• Question: Can you teach after completing DM Course?

Answer: Yes, the candidate can teach in a medical college/hospital after completing the DM course.