The Department of Neurology offers a comprehensive and integrated curriculum in basic and clinical neurological sciences. Didactics and training experiences are offered through all four years of medical school.

Preclinical neurological education — first-and second-year medical students

Acute Stroke Action Program (ASAP)

Temporarily suspended per COVID-19

Join the Acute Stroke Action Program (ASAP), an opportunity for M1s and M2s to carry the acute stroke pager for one to two weeks and race to the ED along with the stroke team to observe the hyperacute management of patients experiencing a stroke.

Students will be able to go about their regular daily routine and only run to the ED when a potential candidate for thrombolytic therapy (tPA) arrives and the stroke pager is activated. This occurs 0-4 times per day, averaging out to once a day. Students who live close enough could come in for night pages too if desired. For patients who are found to have a proximal thrombus and are taken to the angiography suite for mechanical clot retrieval. Interested students could observe the intervention from just outside the room, where everything is visible, including real-time angiographic images.

Learning objectives of the program

  1. Recognize historical features, exam findings, and imaging findings of acute stroke.
  2. Explain how eligibility for tPA administration and mechanical thrombectomy in acute stroke is determined.
  3. Observe/calculate the NIH Stroke Scale as it is performed in a patient with acute stroke.
  4. Describe how consent to administer tPA is obtained.
  5. Appraise the acute stroke treatment process and identify factors that introduced delays.

Interested?

We will reach out when we are able to resume the ASAP. 

Please email questions to Chrissy McIntosh at c.mcintosh@wustl.edu

Helpful information for ASAP participants

ASAP instructions

NIH stroke scale

Pager user guide

First-year Clinical Correlations in Neurosciences selective

This selective is fairly unstructured, consisting of opportunities to shadow a variety of physicians in the neurosciences, including adult or pediatric neurologists, neurointensivists, neuroradiologists, neuropathologists, adult or pediatric neurosurgeons and adult or pediatric psychiatrists.

You may watch a nerve conduction study/electromyogram, brain or spine surgery, angiogram or interventional neuroradiological procedure, or brain cutting. You may review tapes and EEGs of patients being monitored for epilepsy or sleep disturbances. You may attend rounds or shadow a resident on call on neurology, pediatric neurology, neurosurgery, or psychiatry. There are also a number of conferences occurring throughout the week that you may choose to attend.

Although the course description indicates that we will meet weekly from 3-4:30, students in the past have generally opted against meeting as a group during the scheduled time, preferring to spend the rest of the course in the above shadowing and conference activities. If you are interested in more structured teaching, discussion of patient cases, or demonstration of neuro findings on our inpatients, just let me know.

Since this is primarily an enrichment activity, grades are pass-fail. You will all pass as long as you participate in at least three activities, contribute to the Google Docs selective reflections, and send me a brief summary of your shadowing/conference experiences so that I may provide feedback to the preceptors and next year’s selective participants.

Conferences and careers

Neuroscience conference calendar and schedules
Career Opportunities in the neurosciences

Washington University residency/fellowship programs

Neurology residency program
Pediatric neurology residency program
Neurosurgery residency program
Neuroradiology fellowship program
Psychiatry residency program
Child psychiatry fellowship program
Neuropathology fellowship program

Training in the Neurosciences

Neurology

American Board of Psychiatry and Neurology Specialties and Subspecialties

Links:
American Board of Psychiatry and Neurology
American Academy of Neurology
American Neurological Association

Neurosurgery

Links:
American Board of Neurological Surgery
American Association of Neurological Surgeons

Neuroradiology

Links:
American Board of Radiology-Neuroradiology
American Society of Neuroradiology

Psychiatry

American Board of Psychiatry and Neurology
Psychiatry Subspecialization Training

Links:
American Psychiatry Association

Neuropathology

Links:
American Board of Pathology
American Association of Neuropathologists

First-year Alzheimer’s Disease selective

Course master is John Morris, MD. Contact Jennifer Phillips for additional information.

Second-year Diseases of the Nervous System

The required second-year course in neuropathophysiology, directed by Allyson Zazulia, MD, is Diseases of the Nervous System, which integrates neurology, neurosurgery and neuropathology. Coursemaster is Allyson Zazulia, MD.

Resources

Writing learning objectives
Increasing Student Engagement in Lectures

Neurology clerkship and elective opportunities — third- and fourth-year medical students

Third-year required clerkship

Students are immersed in a Neurology Clinical Experience over four weeks. Students are expected to participate as productive and valued team members who take care of patients and make a contribution while under appropriate supervision and guidance.

All students participate in adult inpatient neurology with scheduled outpatient clinical experiences. Additional sub-rotations include adult inpatient and Emergency Department consults with subspecialty clinics, pediatric inpatient consults with pediatric clinics, and inpatient neurosurgery with neurosurgical clinics. The clerkship supports key learning objectives of the neurologic history and exam, oral patient presentations, approach to the patient with neurological symptoms, and knowledge of neurological disease.

Fourth-year elective opportunities

Elective courses are available for fourth-year medical students. We accept visiting fourth-year students from U.S.-affiliated institutions after review by the curriculum office.

M35 815
CONSULT NEUROLOGY
 
Instructor(s): Robert Naismith, M.D., 362-3998
Location: Barnes-Jewish Hospital including Medical Floors, Surgery Floors, Neuro ICU, and the Emergency Department Elective Contact: Lorraine Edrington, 362-3998
Other Information: Visiting students will attend Orientation on the on the first day of the elective. Fourth-year Washington University medical students may begin with their team if they are comfortable with the rotation and already went through the course.
Enrollment limit per period: 2
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.
The student will evaluate patients with neurological manifestations of medical, surgical, and psychiatric diseases. The student will participate in caring for patients under the supervision of the consult resident and attending physician. The student also will attend weekly clinical conferences, including Neurology Grand Rounds.
Student time distribution: Inpatient 90%, Outpatient 5%, Conferences/ Lectures 5%; Subspecialty Care 100%
Major teaching responsibility: Single attending and resident
Patients seen/weekly: 10-15
On call/weekend responsibility: No call/weekends until noon Saturday
M35 816
INPATIENT NEUROLOGY SUBINTERNSHIP
 
Instructor(s): Robert Naismith, M.D., 362-3998
Location: 114-, 11500 Barnes-Jewish Hospital
Elective Contact: Lorraine Edrington, 362-3998
Other Information: Visiting students will attend Orientation on the on the first day of the elective. Fourth-year Washington University medical students may begin with their team if they are comfortable with the rotation and already went through the course.
Enrollment limit per period: 1
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.
Students will function as a subintern on the inpatient neurology service under the supervision of the junior resident, the chief resident, and the attending physicians. The student will also attend weekly clinical conferences. This elective would be a good option for Wash U students who are interested in a career in Neurology, or would like additional Neurology experience before their residency. It would also be good for visiting students interested in Neurology who would like a closer look at our program.
Student time distribution: Inpatient 100%
Major teaching responsibility: Attending physicians, chief residents, junior resident
Patients seen/weekly: 6
On call/weekend responsibility: Every 4th night
M35 830
NEURO-ONCOLOGY
 
Instructor(s): David H. Gutmann, M.D., Ph.D., 362-7379
Location: Suite C, 6th Floor CAM Building
Elective Contact: David H. Gutmann, M.D., Ph.D., 362-7379
Other Information: Students should report to Suite C, 6th Floor CAM Building, 8:30 a.m. first day of elective.
Neuro-Oncology Elective Rotation
Neuro-Oncology Reading Syllabus
Goals and Objectives
Enrollment limit per period: 1
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41. Provide an outpatient-oriented combined pediatric and adult neuro-oncology experience for 4th year medical students. (1) Attend multidisciplinary adult and pediatric neuro-oncology clinics and case conferences (tumor boards); (2) Attend adult and pediatric radiation oncology clinics; (3) Attend neuropathology brain tumor review; (4) Participate in subspecialty brain tumor clinics; (5) Attend monthly brain tumor research conferences.
Student time distribution: Outpatient 90%, Conferences/ Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Team teaching in clinic
Patients seen/weekly: 50 patients
On call/weekend responsibility: None
M35 851
CLINICAL ASPECTS OF AGING AND DEMENTIA
 
Instructor(s): Joy Snider, M.D.
Location: 4488 Forest Park Avenue (two-story brick building at intersection with Taylor)
Elective Contact: Jennifer Phillips, (coordinator) 286-2882
Other Information: Contact Jennifer Phillips a week prior to first day of elective to set up orientation.
ADRC/Dementia Rotation Training Guide
Enrollment limit per period: 1
Valid start weeks for 4-week blocks are: Weeks 9, 13, 17, 21, 29, 33, 37 and 41.
This elective focuses on the characterization of the clinical and cognitive features of healthy brain aging and the distinction of dementia from healthy aging. Students will be exposed to both clinical practice and clinical research aspects of aging and dementia. Students will work with experienced clinicians in a dementia specialty practice (Memory Diagnostic Center) and in a longitudinal research study (Memory and Aging Project) and in ongoing clinical research studies at the Knight Alzheimer’s Disease Research Center (ADRC). Students will learn the differential diagnosis of dementia, including Alzheimer’s disease, dementia with Lewy bodies, frontotemporal dementias, cerebrovascular disorders, and affective disorders. Students will gain proficiency in interviewing techniques and in the neurologic examination of the geriatric patient, be introduced to neuropsychology, neuropathology, biomarkers, neuroimaging, genetics and other biomedical procedures important in the diagnostic evaluation of older adults. Students will have the opportunity to observe assessments in the community and in the long-term care setting. Students will be exposed to clinical therapeutic trials and to strategies in management of patietns with dementing disorders. The Knight-ADRC emphasizes an interdisciplinary approach that includes physicians, nurse clinicians, psychologists and social workers. Students have the option of becoming certified in the Clinical Dementia Rating, the gold standard in dementia staging. Students may opt for additional exposure to neuropathology, neuroimaging or basic science dementia research.
Student time distribution: Research & Clinical Patient Evaluation 80%, Conferences/Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Attending neurologists, psychiatrists and geriatricians involved in the evaluation of memory and aging
Patients seen/weekly: 6-12
On call/weekend responsibility: None
M35 860
PEDIATRIC NEUROLOGY
 
Instructor(s): Douglas Larsen, M.D., M.Ed., 454-6042
Location: 12th Floor, Suite 1260 Northwest Tower
Elective Contact: Lori Nichols, nicholsl@neuro.wustl.edu
Other Information: Students report to
Dr. Larsen on the 12th floor, Suite 1260 Northwest Tower, 8:00 a.m. first day of elective for orientation.
Enrollment limit per period: 1 (Inpatient); 1 (Consultation Office Service)
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.
We offer two senior electives that students may choose between:(1)On our Inpatient Elective, the student participates as a full member of the neurology ward team and is directly responsible for a proportion of patients on the service under the direction of the senior pediatric neurology resident. The student may take night call every third or fourth night, during which time s/he is responsible for the medical care of the entire ward, as well as for emergency admissions under supervision of a pediatric resident. Formal teaching rounds with the attending pediatric neurologist are held two to three times a week, and informal teaching rounds are held daily with the attending and senior residents.(2)On our Outpatient Elective the student will attend daily outpatient clinics, during which time s/he will be able to evaluate outpatient problems under faculty guidance. There are pediatric neurology clinics five days a week, in addition to teaching conferences. This elective allows students to see many new and return patients in a tutorial type of setting since patients are immediately reviewed with senior faculty.A combination of inpatient/outpatient experiences may be arranged on an individual basis to meet the needs of the student.
Student time distribution: Inpatient rotation 80%, Outpatient rotation 80%, Conferences/Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Inpatient: Single attending and senior resident, Outpatient: Multiple attendings
Patients seen/weekly: Inpatient: 5-9, Outpatient: 20-25
On call/weekend responsibility: Inpatient: Every fourth night; Outpatient: None
M35 861
NEUROLOGY/NEUROSURGERY ICU
 
Instructor(s): Michael Diringer, M.D., 362-2999
Location: 10400B Barnes-Jewish Hospital
Elective Contact: Liz Vansickle, 362-2999
Other Information: Students report to 10400 ICU, 7:30 a.m. first day of elective
Enrollment limit per period: 2
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.
The student will be integrated into the Critical Care Team that provides care in the Neurology/Neurosurgery ICU. Diseases frequently encountered include intracerebral hemorrhage, head trauma, subarachnoid hemorrhage, and stroke. The student will follow patients, participate in rounds and perform some procedures under supervision. Didactic sessions will be provided as conferences or lectures from the ICU attending.
Student time distribution: Inpatient 80%, Conferences/Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Fellows and residents
Patients seen/weekly: 25
On call/weekend responsibility: Variable
M35 865
ADULT AND PEDIATRIC EPILEPSY
 
Instructor(s): Edward Hogan, M.D., 362-3944
Location: 11400 EMU Barnes Jewish Hospital
Elective Contact: Donna Theiss, 362-7845, theissd@neuro.wustl.edu
Other Information: Students should meet on 11400 EMU 9:00 a.m. first day of elective.
Enrollment limit per period: 2
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.
Students will learn how epileptologists diagnose and manage epilepsy in adults and children. They will learn how to use the history and physical exam and laboratory studies such as EEG, MRI, PET, and SPECT to diagnose and manage patients with new onset epilepsy, established epilepsy, and medically intractable epilepsy. They will become familiar with the medical management of epilepsy as well as the treatment options for medically intractable epilepsy including surgery, the vagus nerve stimulator, and the ketogenic diet. They will also learn how to manage the co-morbid conditions that accompany epilepsy such as depression, behavioral problems, cognitive impairment, sleep disturbance, and non-epileptic events. Students will accomplish these goals by attending epilepsy clinics and rounding on the inpatient epilepsy service with the epilepsy team at Barnes-Jewish Hospital and St. Louis Children’s Hospital. They will attend the Adult Epilepsy Conference, the Pediatric Epilepsy Conference, and Neurology Grand Rounds. Students will also have the opportunity to observe epilepsy surgery if they wish. They will have the option to present one 15-30 minute talk on a topic relevant to epilepsy.
Student time distribution: Inpatient 70%, Outpatient 10%,
Conferences/Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Attending faculty, fellows
Patients seen/weekly: 40
On call/weekend responsibility: None
M35 871
CLINICAL NEUROIMMUNOLOGY & MULTIPLE SCLEROSIS
 
Instructor(s): Becky Parks, M.D.
Location: 3rd Floor McMillan
Elective Contact: Nanette Bladdick, 362-3307
Other Information: Contact Dr. Parks to arrange time to report on first day of elective.
Enrollment limit per period: 1
Valid start weeks for 4-week blocks are: Weeks 5, 13, 17, 21, 29, 33, 37, and 41.
Students will have the opportunity to interview and examine patients with multiple sclerosis or related neuroimmunological disorders. They will become familiar with the differential diagnosis of MS, appropriate laboratory evaluation and common MRI findings in MS. This elective will also familiarize students with the various immunomodulating agents used to treat MS. In addition to learning about MS in general, they will gain practical knowledge about evaluation and treatment of spasticity, neurogenic bladder, fatigue, cognitive dysfunction, and depression. As time allows they may be able to observe patient evaluations in our clinical trials. 3rd year medical students rotating as part of a core rotation will be expected to attend the required conferences for 3rd year students. Students choosing this elective to gain additional experience in the field of Neurology will be expected to attend Neurology Grand Rounds on Friday morning. Students may also attend our MS Journal Club and the MS Patient Care conference held on the 1st and 3rd Thursdays of every month, respectively.
M80 807
PHYSICAL MEDICINE AND REHABILITATION
 
Instructor(s): Neringa Juknis, M.D., 454-7757, juknisn@neuro.wustl.edu
Location: Suite 2304, Rehabilitation Division, Neurology Department, 4444 Forest Park
Elective Contact: Donna Barbier, 454-7757, barbierd@neuro.wustl.edu
Other Information: Students report to Suite 2304, Rehabilitation Division, Neurology Department, 4444 Forest Park, 8:00 a.m. first day of elective.
Rotation location: The Rehabilitation Institute of St. Louis, 4455 Duncan Ave.
Enrollment limit per period: 1
Valid start weeks for 4-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.
The elective is designed to provide the student with a broad introduction to the field of Physical Medicine and Rehabilitation. Major objective of this clinical elective is to achieve greater knowledge of the neurological and musculoskeletal diseases and their treatment, and gain understanding of basic principles of rehabilitation. The student will learn the clinical and rehabilitative care of patients with strokes, traumatic brain injury, spinal cord trauma and diseases, and limb amputations. Student will gain clinical skills in evaluating in management of functional impairments. Students will be expected to participate in daily rounds on inpatient rehabilitation units with the clinical care team, follow 3-5 patients, attend multidisciplinary team conferences and family meetings, attend outpatient rehabilitation clinics in spinal cord, stroke, traumatic brain injury, and amputee. Teaching and supervision is provided by the physiatry and neurology faculty of the Division of Rehabilitation. Rehabilitation and neurology residents are involved in student teaching as well. Students are required to participate in didactic teaching conferences within the PM&R residency.
This rotation is particularly useful for students considering careers in rehabilitation, neurology, geriatrics, primary care, neurosurgery, or any other field that will require experience in the evaluation and management of patients with physical impairment and disabilities.
Student time distribution: Inpatient 80%, Outpatient 10%, Conferences/Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attending faculty and residents
Patients seen/weekly: 20
On call/weekend responsibility: None
Research opportunities

Looking to get involved in basic or clinical neuroscience research? Many of our faculty have short research descriptions on the Division of Biology and Biomedical Sciences (DBBS) website. Alternatively, you can browse our faculty bio pages.

Beau Ances, MD, 2nd Floor Storz, 747-8423. Neuroimaging of Neurodegenerative Disorders. Students can work in a neuroimaging laboratory that is focused on translational discovery of neuroimaging biomarkers for neurodegenerative diseases. The laboratory focuses on the pathogenesis of HIV dementia and Alzhiemer’s disease. We are investigating the effects of neurodegenerative diseases on brain networks using blood oxygen level dependent imaging and aterial spin labeling. Multiple projects that involve bioengineering, neuroimaging and infectious disease are available depending on the interest of the student.

Randall Bateman, MD, 304 Biotechnology Center, 747-7066. Central nervous system protein metabolism in aging and dementia. This research elective will expose the student to translational research in the study of Alzheimer’s disease. The student will participate in multiple areas of the research including participant consent, enrollment, and admission to a research hospital unit. Lumbar catheter placement and CSF sample collection will be demonstrated. The student will participate in sample analysis including processing for mass spectrometry quantitation, ELISA, and western gel methods. Quantitation, analysis and modeling of the data will be taught in the context of data interpretation and study design.

Maurizio Corbetta, MD, 4525 East Building, 362-7620. The elective will provide hands-on experience in using functional neuroimaging (PET and fMRI) to map regions of the human brain responsible for vision and attention, and to study recovery of function in patients with cognitive deficits (aphasia, neglect) and brain injury.

Anne H. Cross, MD, Third Floor McMillan, 362-3293. Understanding interactions of the immune system with the central nervous system as it relates to multiple sclerosis and other neuroimmunological disorders. Our goal is to understand how immune cells cross the blood-brain barrier and initiate the cascade of events leading to lesions of multiple sclerosis. The student will be given a laboratory project on which to work, which may involve animal models, cell culture or studies of human samples (CSF, blood, autopsied specimens), depending upon the individual interests. Interested students should contact Dr. Cross in advance before signing up for this elective research

Marc Diamond, MD, 305 Biotechnology Building, 286-2165. Molecular Mechanisms and Therapeutics for Neurodegenerative Diseases. Students will have the opportunity to work in a basic science laboratory that is focused on translational discovery: identifying therapeutic mechanisms and developing drugs and drug targets for neurodegenerative diseases. The laboratory is focused on pathogenesis of the tauopathies, and of Huntington disease. In the tauopathies, we are testing the hypothesis that propagation of protein misfolding occurs by transfer of protein aggregates between cells in a manner similar to prions. In Huntington disease, we are using advanced biophysical techniques to identify and characterize proteins that interact with and regulate the misfolding of mutant huntingtin. Multiple projects are available that involve biophysics, biochemistry, cell biology, and animal studies, depending on the interest of the student.

Robert T. Naismith, MD, 310B McMillan, 747-0432. Clinical Imaging Research in Multiple Sclerosis (8 weeks). The student will learn about neuroimaging, imaging analyses, data collection, data management, and clinical study endpoints in multiple sclerosis (MS). They will observe patient participants undergoing a detailed evaluation of disability measures, such as ambulation, symptom scales, cognition, vision, upper extremity function, etc. They will witness the entire process of image acquisition, processing, analyses and data extraction. They will have the opportunity to interact with many people who are vital to the research, including research coordinators, imaging technologists, imaging physicists/chemists, and specialized research clinicians (i.e. neurocognitive and physical therapy research specialists).

The student will assist with hands-on clinical investigative research. They will gain an excellent appreciation of MS, from its pathophysiology within the central nervous system, to how it affects the neurological function of individuals. Through detailed and quantitative imaging analysis, the student will become very adept at analyzing brain MRI scans. They will marks and track lesions, determine their effects on clinical function, normal appearing white matter, cortex, and gray-matter structures. They will become familiar with Amira Imaging Analysis Software, SPSS Statistical Analysis Software, SIENA Volume Analysis Software and Matlab Imaging Analysis Software.

Steven E. Petersen, PhD, 2108 East Building, 362-3319. This lab is interested in the functional localization of higher brain processes, particularly those processes related to language, memory and visual attention. Our main approach to these issues is the use of PET and fMRI activation, but we also study task performance in normal and selected patient populations.

Joel S. Perlmutter, MD, Second Floor East Building, 362-6026. Pathophysiology of Movement Disorders. The lab is primarily interested in etiology, pathophysiology and treatment of basal ganglia disorders. We have several studies of PD. We investigate mechanisms of action of deep brain stimulation, a dramatic new treatment. These studies combine PET, cognitive testing and quantified measures of movement. We also test new drugs that might rescue injured nigrostriatal neurons (a model of PD). For these, we use PET to measure dopamine pathways and also quantify motor behavior. We also have an active program developing and validation neuroimaging biomarkers for PD and integrity of the nigrostriatal pathway that includes studies in people and animal models of PD. We have an active program combining a variety of approaches to develop biomarkers and investigate the pathophysiology of dementia associated with PD. We use PET to measure radioligand binding and sensorimotor processing in dystonia. We developed a new animal model of dystonia to investigate pharmacologic and physiologic changes. We use PET to investigate drug-mediated pathways in the brain and parse out the effects of selective dopaminergic agonists. We also are working to develop MR-based methods including DTI and resting-state functional connectivity to investigate brain mechanisms underlying PD and dystonia.

Marcus E. Raichle, MD, Neuro Imaging Laboratory, Second Floor East Building, 362-6907. In vivo brain hemodynamic, metabolic and functional studies of human cognition and emotion using cyclotron-produced isotopes and emission tomography (PET) as well as functional magnetic resonance imaging (fMRI) in humans. See also Steven E. Petersen, PhD.

B. Joy Snider, MD, PhD, Biotechnology Building Room 225, 747-2107. Protein degradation and calcium homeostasis in cellular models of neurodegenerative disorders. We study regulation and dysfunction of the ubiquitin-proteasome system in cultured cells, including primary neuronal cultures. A second set of projects is aimed at elucidating the role of intracellular calcium homeostasis in neuronal dysfunction and death.

Gregory Wu, MD, PhD, Third Floor McMillan, 362-3293. Understanding how immune responses are generated that target the central nervous system. Specifically, studies on antigen presentation cell contributions to autoimmune animal models of multiple sclerosis. Our goal is to understand what cellular interactions are critical to the development of immune-mediated demyelination.