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Book Details
Abstract
Clinical Neurophysiology is aimed at bedside clinical application of neurophysiological tests, with emphasis on clinical problem solving. Highly illustrated format including line diagrams, clinical photographs, CT scan and MRI pictures with corresponding neurophysiological findings is a special feature of this book.
Clinical Neurophysiology is written by clinicians for fellow clinicians. This book will be useful to all those ordering, conducting or interpreting electrodiagnostic tests, especially students and clinicians in the areas of neurology, neurosurgery, and pediatrics.
The exposition is systematically organized into the following three parts:
Nerve Conduction: It discusses the basis of electrodiagnostic signals and their measurements. The techniques of performing nerve conduction tests of various nerves have been illustrated with a series of simple line diagrams.
Electromyography: It deals with the basis of EMG signals, their recording and interpretation. The application of myography in various myopathies and neurogenic disorders has been discussed in detail. A review of single fiber electromyography is included.
Evoked Potentials: This covers visual, brainstem, somatosensory and motor evoked potentials.
New to this Edition
- Three chapters: Electrodiagnosis in Pediatric Practice, Cognitive Evoked Potential, and Role of Clinical Neurophysiology in Prognosis of Neuromuscular Disorders.
- Updation of all chapters in the light of recent advances in genetics, immunology, molecular diagnosis, and neurophysiology.
- Extensive revision of Electromyography, Clinical Application of Electromyography and Nerve Conduction, and Repetitive Nerve Stimulation.
- Many additional illustrations highlighting the clinical applications of various tests.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover\r | Front Cover | ||
| Front Matter\r | i | ||
| Copyright\r | iv | ||
| Dedicated | v | ||
| Preface To The Second Edition\r | vii | ||
| Preface To The First Edition\r | ix | ||
| Acknowledgements\r | xi | ||
| Contents\r | xiii | ||
| Chapter 1 - History of Clinical Neurophysiology | 1 | ||
| Classic Electrodiagnosis | 2 | ||
| Electromyography and Nerve Stimulation Technique | 4 | ||
| Evoked Potentials | 7 | ||
| Miscellaneous | 8 | ||
| Chapter 2 - An Introduction to Electrodiagnostic Signals and their Measurements\r | 11 | ||
| Biophysics | 11 | ||
| Electrodes | 12 | ||
| Filter | 13 | ||
| Amplifier | 15 | ||
| Averager | 16 | ||
| Display | 16 | ||
| Gain and Sweep Time | 17 | ||
| Signal Trigger and Delay Line | 18 | ||
| Stimulator | 18 | ||
| Referral Process | 19 | ||
| Chapter 3 - Nerve Conduction Study\r | 21 | ||
| Principles of Nerve Conduction Study | 21 | ||
| Anatomy and Physiology | 21 | ||
| Axonal Transport | 22 | ||
| Impulse Propagation | 23 | ||
| Principles of Motor Nerve Conduction | 24 | ||
| Principles of Sensory Nerve Conduction | 26 | ||
| Variables Affecting the Nerve Conduction Study | 28 | ||
| Physiological Variables | 28 | ||
| Age | 28 | ||
| Upper versus Lower Limb | 28 | ||
| Temperature | 28 | ||
| Technical Variables | 28 | ||
| Stimulating System | 28 | ||
| Recording System | 29 | ||
| Inadvertent Stimulation of Unintended Nerves | 29 | ||
| Anomalous Crossover Between the Nerves | 29 | ||
| Median Nerve | 31 | ||
| Anatomy | 31 | ||
| Nerve Conduction Study | 31 | ||
| Median Motor Nerve Conduction | 31 | ||
| Median Sensory Nerve Conduction | 32 | ||
| Median Nerve Entrapment Syndromes | 32 | ||
| Carpal Tunnel Syndrome | 32 | ||
| Neurophysiological Diagnosis of CTS | 34 | ||
| Needle Electromyography | 36 | ||
| Special Precautions in the Evaluation of CTS | 36 | ||
| Assessment of Severity of CTS | 36 | ||
| Postsurgical Evaluation | 36 | ||
| Anterior Interosseous Syndrome | 37 | ||
| Neurophysiological Diagnosis of Anterior Interosseous Syndrome | 37 | ||
| Ulnar Nerve | 39 | ||
| Pronator Teres Syndrome | 37 | ||
| Ulnar Motor Nerve Conduction | 39 | ||
| Ulnar Sensory Nerve Conduction | 40 | ||
| Dorsal Branch of Ulnar Nerve | 41 | ||
| Ulnar Neuropathy at Elbow | 41 | ||
| Radial Nerve | 47 | ||
| Electrophysiological Evaluation of Ulnar Neuropathy at Elbow | 43 | ||
| Ulnar Neuropathy at Distal Forearm | 44 | ||
| Ulnar Neuropathy at Wrist | 44 | ||
| Electrodiagnostic Evaluation of Ulnar Neuropathy at Wrist | 45 | ||
| Brachial Plexus | 52 | ||
| Upper plexus | 56 | ||
| Middle plexus | 56 | ||
| Lower plexus | 56 | ||
| Infraclavicular Plexus Assessment | 57 | ||
| Lateral cord | 57 | ||
| Posterior cord | 57 | ||
| Medial cord | 57 | ||
| Terminal Nerves | 57 | ||
| EVALUATION OF “NONSTANDARD” NERVES OFBRACHIAL PLEXUS | 57 | ||
| Suprascapular Nerve | 57 | ||
| Long Thoracic Nerve | 57 | ||
| Axillary Nerve | 58 | ||
| Musculocutaneous Nerve | 58 | ||
| Lateral Antebrachial Cutaneous Nerve | 59 | ||
| Medial Antebrachial Cutaneous Nerve | 60 | ||
| THORACIC OUTLET OBSTRUCTION | 61 | ||
| BRACHIAL NEURITIS | 62 | ||
| RADIATION-INDUCED PLEXOPATHY | 63 | ||
| OBSTETRIC BRACHIAL PLEXOPATHY | 63 | ||
| Cervical Radiculopathy | 67 | ||
| ANATOMY | 67 | ||
| MOTOR AND SENSORY NERVECONDUCTION | 67 | ||
| F WAVE | 67 | ||
| SOMATOSENSORY EVOKED POTENTIALS | 68 | ||
| NERVE ROOT STIMULATION | 68 | ||
| NEEDLE ELECTROMYOGRAPHY | 68 | ||
| CERVICAL RADICULOPATHY | 70 | ||
| C7 RADICULOPATHY | 71 | ||
| C5-C6 RADICULOPATHY | 71 | ||
| C8-T1 RADICULOPATHY | 71 | ||
| DIFFERENTIAL DIAGNOSIS OF CERVICAL RADICULOPATHY | 71 | ||
| Lumbar Plexus and its Terminal Branches | 73 | ||
| Chapter 4 - Electromyography\r | 129 | ||
| Introduction to Electromyography | 129 | ||
| ANATOMY OF MUSCLE | 129 | ||
| TYPES OF EMG NEEDLE ELECTRODES | 130 | ||
| CONCENTRIC NEEDLE ELECTRODE | 130 | ||
| MONOPOLAR NEEDLE ELECTRODE | 131 | ||
| SINGLE FIBER (SF) NEEDLE ELECTRODE | 131 | ||
| MACRO ELECTRODE | 131 | ||
| RECORDING TECHNIQUE | 131 | ||
| INSERTIONAL ACTIVITY | 132 | ||
| SPONTANEOUS ACTIVITY | 132 | ||
| Normal Spontaneous Activities Originated fromthe Neuromuscular Junction or Terminal Axon(Endplate Noise and Endplate Spike) | 132 | ||
| ABNORMAL SPONTANEOUS ACTIVITIES ORIGINATING FROMMUSCLE FIBER | 132 | ||
| Fibrillations and Positive Sharp Waves | 132 | ||
| Myotonic Discharges | 134 | ||
| Complex Repetitive Discharges (CRDs) | 134 | ||
| ABNORMAL SPONTANEOUS ACTIVITIES ORIGINATING FROMMOTOR NEURON OR AXON | 135 | ||
| Fasciculations | 135 | ||
| Doublets, Triplets, and Multiplets | 136 | ||
| Myokymic Discharges | 136 | ||
| Neuromyotonia | 137 | ||
| NORMAL MOTOR UNIT POTENTIAL | 137 | ||
| Cramp Potentials | 137 | ||
| Morphology | 138 | ||
| Duration of Motor Unit Potential | 138 | ||
| Rise Time of Motor Unit Potential | 139 | ||
| Amplitude of Motor Unit Potential | 139 | ||
| Phase of Motor Unit Potential | 139 | ||
| Satellite Potential | 139 | ||
| Stability of Motor Unit Potential | 140 | ||
| Firing Pattern of MUP | 140 | ||
| Evaluation of Motor Unit Potential | 140 | ||
| Abnormalities of Motor Unit Potentials | 141 | ||
| Long duration motor unit potentials | 141 | ||
| Polyphasic motor unit potentials | 141 | ||
| Mixed pattern | 142 | ||
| Abnormal Recruitment of Motor Unit Potential | 142 | ||
| Interference | 142 | ||
| Technique of Electromyography | 145 | ||
| MUSCLES OF HANDS | 145 | ||
| ABDUCTOR DIGITI MINIMI (C8, T1 ROOTS,ULNAR NERVE, FIG. 4.15) | 145 | ||
| OPPONENS DIGITI MINIMI (C8, T1 ROOTS,ULNAR NERVE, FIG. 4.16) | 145 | ||
| ADDUCTOR POLLICIS (C8, T1 ROOTS,ULNAR NERVE, FIG. 4.17) | 145 | ||
| FIRST DORSAL INTEROSSEOUS (C8, T1 ROOTS,ULNAR NERVE, FIG. 4.18) | 145 | ||
| LUMBRICALS (C8, T1 ROOTS, I AND II BY MEDIAN ANDIII AND IV BY ULNAR NERVE, FIG. 4.19 | 146 | ||
| ABDUCTOR POLLICIS BREVIS (C8, T1 ROOTS,MEDIAN NERVE, FIG. 4.20) | 146 | ||
| FLEXOR POLLICIS BREVIS (C8, T1 ROOTS, SUPERFICIALHEAD BY MEDIAN AND DEEP HEAD BY ULNAR NERVE,FIG. 4.21) | 146 | ||
| OPPONENS POLLICIS (C8, T1 ROOT,MEDIAN NERVE, FIG. 4.22) | 147 | ||
| MUSCLES OF FOREARM | 147 | ||
| ABDUCTOR POLLICIS LONGUS (C7, C8 ROOTS,RADIAL NERVE, FIG. 4.23) | 147 | ||
| EXTENSOR DIGITORUM COMMUNIS (C7, C8 ROOTS,RADIAL NERVE, FIG. 4.24) | 147 | ||
| EXTENSOR CARPI ULNARIS (C7, C8 ROOTS,RADIAL NERVE, FIG. 4.25) | 148 | ||
| EXTENSOR CARPI RADIALIS LONGUS AND BREVIS(C7, C8 ROOTS, RADIAL NERVE, FIG. 4.26) | 148 | ||
| ANCONEUS (C7, C8 ROOTS, RADIAL NERVE, FIG. 4.27) | 148 | ||
| BRACHIORADIALIS (C5, C6 ROOTS, RADIAL NERVE, FIG. 4.28) | 149 | ||
| EXTENSOR POLLICIS BREVIS (C7, C8 ROOTS,RADIAL NERVE, FIG. 4.29) | 149 | ||
| EXTENSOR POLLICIS LONGUS (C7, C8 ROOTS,RADIAL NERVE, FIG. 4.30) | 150 | ||
| SUPINATOR (C6, C7 ROOTS, RADIAL NERVE, FIG. 4.31) | 150 | ||
| FLEXOR CARPI RADIALIS (C6, C7 ROOTS,MEDIAN NERVE, FIG. 4.32) | 150 | ||
| FLEXOR CARPI ULNARIS (C7, C8 ROOTS,ULNAR NERVE, FIG. 4.33) | 150 | ||
| FLEXOR DIGITORUM PROFUNDUS (C8, T1 ROOTS,ULNAR AND MEDIAN NERVE, FIG. 4.34) | 151 | ||
| FLEXOR DIGITORUM SUBLIMIS (C7, C8, AND T1 ROOTS,MEDIAN NERVE, FIG. 4.35) | 151 | ||
| FLEXOR POLLICIS LONGUS (C8, T1 ROOTS,MEDIAN NERVE, FIG. 4.36) | 151 | ||
| PALMARIS LONGUS (C7, C8 ROOTS, MEDIANNERVE, FIG. 4.37) | 152 | ||
| PRONATOR QUADRATUS (C7, C8 ROOTS,MEDIAN NERVE, FIG. 4.38) | 152 | ||
| PRONATOR TERES (C6, C7 ROOTS,MEDIAN NERVE, FIG. 4.39) | 152 | ||
| MUSCLES OF ARM | 153 | ||
| BICEPS BRACHII (C5, C6 ROOTS,MUSCULOCUTANEOUS NERVE, FIG. 4.40) | 153 | ||
| BRACHIALIS (C5, C6 ROOTS, MAINLY MUSCULOCUTANEOUSNERVE AND MINIMALLY BY RADIAL NERVE, FIG. 4.41) | 153 | ||
| TRICEPS (C7, C8 ROOTS, RADIAL NERVE, FIG. 4.42) | 153 | ||
| MUSCLES OF SHOULDERGIRDLE AND TRUNK | 154 | ||
| DELTOID (C5, C6 ROOTS, AXILLARY NERVE, FIG. 4.43) | 154 | ||
| SUPRASPINATUS (C5 AND C6 ROOTS,SUPRASCAPULAR NERVE, FIG. 4.44) | 154 | ||
| INFRASPINATUS (C5 AND C6 ROOTS,SUPRASCAPULAR NERVE, FIG. 4.45) | 154 | ||
| LATISSIMUS DORSI (C7, C8, AND T1 ROOTS,THORACODORSAL NERVE, FIG. 4.46) | 154 | ||
| TERES MAJOR (C5 AND C6 ROOTS,SUBSCAPULAR NERVE, FIG. 4.47) | 154 | ||
| TERES MINOR (C5 ROOT, AXILLARY NERVE, FIG. 4.48) | 155 | ||
| LEVATOR SCAPULAE (C4 AND C5 ROOTS, SPINAL ACCESSORYWITH BRANCHES FROM DORSAL SCAPULAR NERVE, FIG. 4.49) | 155 | ||
| RHOMBOIDEUS MAJOR AND MINOR (C5 ROOT,DORSAL SCAPULAR NERVE, FIGS 4.50 AND 4.51) | 155 | ||
| SERRATUS ANTERIOR (C5, C6, AND C7 ROOTS,LONG THORACIC NERVE, FIG. 4.52) | 156 | ||
| TRAPEZIUS (C3 AND C4 ROOTS, XI CRANIAL NERVE WITHSPINAL ACCESSORY, FIG. 4.53) | 156 | ||
| PECTORALIS MAJOR (C5–C8 AND T1 ROOTS, MEDIAL ANDLATERAL PECTORAL NERVES, FIG. 4.54) | 157 | ||
| PECTORALIS MINOR (C7, C8, AND T1 ROOTS, MEDIAL ANDLATERAL PECTORAL NERVE, FIG. 4.55) | 157 | ||
| RECTUS ABDOMINIS (T5–T12 ROOTS, FIG. 4.56) | 157 | ||
| PARASPINAL MUSCLES (CORRESPONDING ROOTS,POSTERIOR RAMI, FIG. 4.57) | 157 | ||
| DIAPHRAGM (C3–C5 ROOTS, PHRENIC NERVE, FIG. 4.58) | 158 | ||
| MUSCLE OF THE FOOT | 158 | ||
| ABDUCTOR DIGITI MINIMI (S1 AND S2 ROOTS,LATERAL PLANTAR NERVE, FIG. 4.59) | 158 | ||
| ABDUCTOR HALLUCIS (S1 AND S2 ROOTS,MEDIAL PLANTAR NERVE, FIG. 4.60) | 158 | ||
| ADDUCTOR HALLUCIS (S1 AND S2 ROOTS,LATERAL PLANTAR NERVE, FIG. 4.61) | 159 | ||
| FLEXOR DIGITORUM BREVIS (L5 AND S1 ROOTS,MEDIAL PLANTAR NERVE, FIG. 4.62 | 159 | ||
| FLEXOR DIGITI MINIMI (S1 AND S2 ROOTS,LATERAL PLANTAR NERVE, FIG. 4.63) | 159 | ||
| FLEXOR HALLUCIS BREVIS (L5 AND S1 ROOTS,MEDIAL PLANTAR NERVE, FIG. 4.64) | 159 | ||
| EXTENSOR DIGITORUM BREVIS (L5 AND S1 ROOTS,DEEP PERONEAL NERVE, FIG. 4.65) | 160 | ||
| INTEROSSEI (S1 AND S2 ROOTS,LATERAL PLANTAR NERVE, FIG. 4.66) | 160 | ||
| MUSCLES OF LEG | 160 | ||
| TIBIALIS ANTERIOR (L4, L5, AND S1 ROOTS,DEEP PERONEAL NERVE, FIG. 4.67) | 160 | ||
| EXTENSOR DIGITORUM LONGUS (L4, L5, AND S1ROOTS, DEEP PERONEAL NERVE, FIG. 4.68) | 160 | ||
| EXTENSOR HALLUCIS LONGUS (L4, L5, AND S1ROOTS, DEEP PERONEAL NERVE, FIG. 4.69) | 161 | ||
| PERONEUS LONGUS (L4, L5, AND S1 ROOTS,SUPERFICIAL PERONEAL NERVE, FIG. 4.70) | 161 | ||
| PERONEUS BREVIS (L4, L5, AND S1 ROOTS,SUPERFICIAL PERONEAL NERVE, FIG. 4.71) | 161 | ||
| PERONEUS TERTIUS (L4, L5, AND S1 ROOTS,DEEP PERONEAL NERVE, FIG. 4.72) | 161 | ||
| FLEXOR HALLUCIS LONGUS (L5 AND S1 ROOTS,TIBIAL NERVE, FIG. 4.73) | 162 | ||
| FLEXOR DIGITORUM LONGUS (L5, S1 ROOTS,TIBIAL NERVE, FIG. 4.74) | 162 | ||
| GASTROCNEMIUS (L5, S1, AND S2 ROOTS,TIBIAL NERVE, FIG. 4.75) | 162 | ||
| POPLITEUS (L5 ROOT, TIBIAL NERVE, FIG. 4.76) | 163 | ||
| SOLEUS (L5, S1, AND S2 ROOTS, TIBIAL NERVE, FIG. 4.77) | 163 | ||
| TIBIALIS POSTERIOR (L5, S1 ROOTS, TIBIAL NERVE, FIG. 4.78) | 163 | ||
| MUSCLES OF THIGH | 163 | ||
| ADDUCTOR LONGUS (L2, L3, AND L4 ROOTS,OBTURATOR NERVE, FIG. 4.79) | 163 | ||
| ADDUCTOR BREVIS (L2, L3, AND L4 ROOTS,OBTURATOR NERVE, FIG. 4.80) | 163 | ||
| ADDUCTOR MAGNUS (L2–L4 ROOTS, OBTURATOR NERVEAND A BRANCH FROM SCIATIC NERVE, FIG. 4.81) | 164 | ||
| GRACILIS (L2, L3, AND L4 ROOTS,OBTURATOR NERVE, FIG. 4.82) | 164 | ||
| RECTUS FEMORIS (L2, L3, AND L4 ROOTS,FEMORAL NERVE, FIG. 4.83) | 164 | ||
| SARTORIUS (L2–L4 ROOTS, FEMORAL NERVE, FIG. 4.84) | 164 | ||
| VASTUS INTERMEDIUS (L2–L4 ROOTS,FEMORAL NERVE, FIG. 4.85) | 164 | ||
| VASTUS LATERALIS (L2–L4 ROOTS,FEMORAL NERVE, FIG. 4.86) | 165 | ||
| VASTUS MEDIALIS (L2–L4 ROOTS,FEMORAL NERVE, FIG. 4.87) | 165 | ||
| BICEPS FEMORIS (LONG HEAD L5, S1, AND S2 ROOTS, TIBIALDIVISION OF SCIATIC NERVE, FIG. 4.88; SHORT HEAD L5–S1ROOTS, PERONEAL DIVISION OF SCIATIC NERVE, FIG. 4.89) | 165 | ||
| SEMIMEMBRANOSUS (L5, S1, AND S2 ROOTS,TIBIAL DIVISION OF SCIATIC NERVE, FIG. 4.90) | 166 | ||
| SEMITENDINOSUS (L5–S2 ROOTS, TIBIAL DIVISION OFSCIATIC NERVE, FIG. 4.91) | 166 | ||
| MUSCLES OF PELVIC GIRDLE | 166 | ||
| ILIOPSOAS (L2, L3, AND L4 ROOTS,FEMORAL NERVE, FIG. 4.92) | 166 | ||
| PECTINEUS (L2, L3, AND L4 ROOTS,FEMORAL NERVE, FIG. 4.93) | 166 | ||
| TENSOR FASCIA LATA (L4, L5, AND S1 ROOTS,SUPERIOR GLUTEAL NERVE, FIG. 4.94) | 167 | ||
| GLUTEUS MAXIMUS (L5, S1, AND S2 ROOTS,INFERIOR GLUTEAL NERVE, FIG. 4.95) | 167 | ||
| GLUTEUS MEDIUS (L4, L5, AND S1 ROOTS,SUPERIOR GLUTEAL NERVE, FIG. 4.96) | 167 | ||
| GLUTEUS MINIMUS (L4, L5, AND S1 ROOTS,SUPERIOR GLUTEAL NERVE, FIG. 4.97) | 167 | ||
| PIRIFORMIS (S1 AND S2 ROOTS, NERVE TOPIRIFORMIS, FIG. 4.98) | 167 | ||
| MUSCLES OF FACE, HEAD AND NECK | 168 | ||
| TEMPORALIS (VTH CRANIAL NERVE, FIG. 4.99) | 168 | ||
| MASSETER (VTH CRANIAL NERVE, FIG. 4.100) | 168 | ||
| MEDIAL PTERYGOID (VTH CRANIAL NERVE,FIG. 4.101) | 168 | ||
| GENIOGLOSSUS (XIITH CRANIAL NERVE, FIG. 4.102) | 169 | ||
| FRONTALIS (VIITH CRANIAL NERVE, FIG. 4.103) | 169 | ||
| ORBICULARIS OCULI (VIITH CRANIAL NERVE, FIG. 4.104) | 169 | ||
| NASALIS (VIITH CRANIAL NERVE, FIG. 4.105) | 169 | ||
| MENTALIS (VIITH CRANIAL NERVE, FIG. 4.106) | 169 | ||
| ORBICULARIS ORIS (VIITH CRANIAL NERVE, FIG. 4.107) | 170 | ||
| PLATYSMA (VIITH CRANIAL NERVE, FIG. 4.108) | 170 | ||
| CRICOTHYROID (XTH CRANIAL NERVE, FIG. 4.109) | 170 | ||
| TONGUE MUSCLES (XIITH CRANIAL NERVE, FIG. 4.110) | 170 | ||
| Chapter 5 - Clinical Application of EMG and Nerve Conduction\r | 171 | ||
| Electromyographic Findings in Neurologic Disorders | 171 | ||
| Neurogenic Disorders | 171 | ||
| Amyotrophic Lateral Sclerosis | 171 | ||
| Electrodiagnostic Tests in ALS | 172 | ||
| Needle EMG | 173 | ||
| Active Denervation | 173 | ||
| Chronic Denervation | 173 | ||
| Large Motor Unit Potentials (MUP Remodeling) | 173 | ||
| Unstable motor units | 174 | ||
| Reduced interference pattern | 174 | ||
| Fasciculations | 174 | ||
| Nerve Conduction Studies | 174 | ||
| Motor Nerve Conduction | 174 | ||
| Sensory Nerve Conduction Studies | 175 | ||
| Repetitive Nerve Stimulation (RNS) | 176 | ||
| Motor Unit Number Estimate | 176 | ||
| Differential Diagnosis of ALS | 176 | ||
| Multifocal motor neuropathy | 176 | ||
| Inclusion body myositis | 176 | ||
| Summary of Electrodiagnostic Approach in a Patient Suspected of ALS | 177 | ||
| Spinal Muscular Atrophy (SMA) | 178 | ||
| Nonprogressive Juvenile Spinal Muscular Atrophy (Hirayama Disease) | 178 | ||
| Syringomyelia | 180 | ||
| Poliomyelitis | 180 | ||
| Postpolio Syndrome | 181 | ||
| Miscellaneous Spinal Cord Diseases | 181 | ||
| Myopathic Disorders | 182 | ||
| Electrodiagnostic Testing in Myopathy | 183 | ||
| Myopathic MUPs with Fibrillations | 183 | ||
| Myopathic MUPS without Fibrillations | 183 | ||
| Myopathic MUPs With Myotonic Discharges | 183 | ||
| Normal Electromyogram | 184 | ||
| Inflammatory Muscle Disease | 185 | ||
| Diagnostic Difficulty in Inflammatory Myopathy | 187 | ||
| Duchenne Muscular Dystrophy | 189 | ||
| Becker Muscular Dystrophy (BMD) | 191 | ||
| Emery-Dreifuss Muscular Dystrophy (EDMD) | 191 | ||
| Facioscapulohumeral Muscular Dystrophy | 191 | ||
| Oculopharyngeal Muscular Dystrophy | 192 | ||
| Limb Girdle Muscular Dystrophy | 192 | ||
| Autosomal Dominant LGMD (LGMD1) | 193 | ||
| Autosomal Recessive LGMDs (LGMD2) | 193 | ||
| Myotonic Dystrophies | 193 | ||
| Myotonic Dystrophy Type 1 (DM1) | 193 | ||
| Myotonic Dystrophy Type 2 (DM2) | 195 | ||
| Myotonia Congenita and Paramyotonia | 197 | ||
| Congenital Myopathies | 198 | ||
| Central Core Myopathy | 198 | ||
| Nemaline Myopathy | 198 | ||
| Centronuclear Myopathy | 199 | ||
| Congenital Muscular Dystrophies | 199 | ||
| Fukuyama Muscular Dystrophy (FCMD) | 199 | ||
| Distal Myopathies | 199 | ||
| Welander Distal Myopathy | 200 | ||
| Tibial Muscular Dystrophy/Markesbery-Griggs/Udd | 200 | ||
| Miyoshi Distal Myopathy | 200 | ||
| Metabolic Myopathies | 202 | ||
| Disorders of Muscle Energy Metabolism | 202 | ||
| Acid Maltase Deficiency (Type II Glycogenosis) | 202 | ||
| Debrancher Enzyme Deficiency (Type III Glycogenosis) | 202 | ||
| Branching Enzyme Deficiency (Type IV Glycogenosis) | 202 | ||
| Myophosphorylase Deficiency (Type V Glycogenosis, McArdle Disease) | 202 | ||
| Phosphorylase B Kinase Deficiency | 203 | ||
| Phosphofructokinase (PFK) Deficiency, Type VII Glycogen Storage Disease | 203 | ||
| Phosphoglycerate Kinase Deficiency (Type IX Glycogenosis) | 203 | ||
| Phosphoglycerate Mutase Deficiency (Type X Glycogenosis) | 203 | ||
| Lactate Dehydrogenase Deficiency (LDH) (Type XI Glycogenosis) | 203 | ||
| Disorders of Lipid Metabolism | 203 | ||
| Carnitine Deficiency | 203 | ||
| Carnitine Palmitoyl Transferase Deficiency | 204 | ||
| Myoadenylate Deaminase Deficiency | 204 | ||
| Mitochondrial Myopathies | 204 | ||
| Kearn-Sayre Syndrome (KSS) | 204 | ||
| Myoclonic Epilepsy with Ragged Red Fibers (MERRF) | 204 | ||
| Mitochondrial Myopathy, Lactic Acidosis, and Stroke | 204 | ||
| Mitochondrial Myopathies Associated with Recurrent Myoglobinuria | 205 | ||
| Mitochondrial DNA Depletion Syndrome | 205 | ||
| Progressive External Ophthalmoplegia Syndrome and Ragged Red Fibers | 205 | ||
| Periodic Paralysis | 205 | ||
| Endocrine Myopathies | 207 | ||
| Thyroid Disorders | 207 | ||
| Thyrotoxic Myopathy | 207 | ||
| Thyroid-Associated Ophthalmopathy | 207 | ||
| Thyrotoxic Periodic Paralysis | 207 | ||
| Hypothyroid Myopathy | 208 | ||
| Myasthenia Gravis | 209 | ||
| Adrenal Disorders | 209 | ||
| Cushing Syndrome and Steroid Myopathy | 209 | ||
| Myopathy with Aldosterone Excess | 211 | ||
| Myopathy with Parathyroid Disorders | 212 | ||
| Toxic Myopathies | 212 | ||
| Pathophysiological Basis of Nerve Conduction Study | 217 | ||
| Nerve Conduction and EMG Studies in Polyneuropathies | 217 | ||
| Conduction Block and Temporal Dispersion | 218 | ||
| Neurophysiological Classification of Polyneuropathy | 219 | ||
| Uniform Demyelinating Motor Sensory Polyneuropathy | 219 | ||
| Segmental Demyelinating, Motor More Than Sensory Neuropathy | 220 | ||
| Axonal, Motor More Than Sensory Polyneuropathy | 220 | ||
| Sensory Axonal Polyneuropathy | 220 | ||
| Axonal Type of Mixed Sensory Motor Polyneuropathy | 221 | ||
| Mixed Axonal Loss and Demyelinating Neuropathy | 222 | ||
| Limitation of Nerve Conduction Studies | 223 | ||
| Hereditary Neuropathies | 224 | ||
| Classification of Inherited Neuropathies | 224 | ||
| Nerve Conduction Study in Hereditary Neuropathy | 225 | ||
| Hereditary Motor Sensory Neuropathy Type I (HSMN I) | 227 | ||
| Hereditary Motor Sensory Neuropathy (HMSN) Type III (Dejerine Sottas Disease) | 228 | ||
| Charcot-Marie-Tooth Disease IV (CMT-IV) | 229 | ||
| Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) | 229 | ||
| Charcot-Marie-Tooth Disease II (CMT-II) | 230 | ||
| Hereditary Sensory Autonomic Neuropathy | 230 | ||
| Refsum Disease | 230 | ||
| Leucodystrophy | 230 | ||
| Metachromatic Leucodystrophy (MLD) | 231 | ||
| Krabbe's Disease | 232 | ||
| Adrenoleucodystrophy | 232 | ||
| Cockayne Syndrome | 232 | ||
| Cerebrotendinous Xanthomatosis | 232 | ||
| Tangier Disease | 232 | ||
| Friedreich Ataxia | 233 | ||
| Giant Axonal Neuropathy (GAN) | 233 | ||
| Familial Amyloid Polyneuropathy | 233 | ||
| Acute Inflammatory Demyelinating Polyneuropathy (AIDP) | 233 | ||
| Distribution of Demyelination in GBS | 235 | ||
| Improving the Diagnostic Yield of Neurophysiological Tests in GBS | 236 | ||
| Subgroups and Overlap of GBS | 236 | ||
| Primary Axonal GBS | 236 | ||
| Miller Fisher Syndrome | 237 | ||
| Polyneuritis Cranialis Variant | 237 | ||
| Chronic Inflammatory Demyelinating Polyneuropathy | 238 | ||
| Neurophysiological Evaluation | 239 | ||
| Differential Diagnosis | 240 | ||
| Variants of CIDP | 240 | ||
| CIDP with Diabetes Mellitus | 240 | ||
| Subacute Idiopathic Demyelinating Polyradiculopathy (SIDP) | 240 | ||
| Motor Neuropathy with Multifocal Conduction Block or Multifocal Motor Neuropathy (MMN) | 241 | ||
| Clinical Picture | 241 | ||
| Neurophysiological Evaluation | 242 | ||
| Neuropathy Associated with Aids | 244 | ||
| Inflammatory Demyelinating Neuropathies | 244 | ||
| Distal Symmetrical Polyneuropathy | 244 | ||
| Mononeuropathy and Multiple Mononeuropathies | 245 | ||
| Progressive Polyradiculoneuropathy | 245 | ||
| Autonomic Neuropathy | 246 | ||
| Leprosy | 246 | ||
| Clinical Features | 246 | ||
| Peripheral Neuropathy in Tuberculoid Leprosy | 247 | ||
| Lepromatous Leprosy | 248 | ||
| Neuropathy in Borderline Leprosy | 248 | ||
| Pure Neural Leprosy | 248 | ||
| Electrodiagnostic Studies | 248 | ||
| Diphtheritic Neuropathy | 250 | ||
| Metabolic Neuropathy | 250 | ||
| Diabetic Neuropathy | 250 | ||
| Distal Symmetrical Diabetic Neuropathy | 250 | ||
| Painful Diabetic Neuropathy | 251 | ||
| Pure Motor Neuropathy | 251 | ||
| Autonomic Neuropathy | 251 | ||
| Asymmetric Proximal Diabetic Neuropathy | 251 | ||
| Diabetic Truncal Neuropathy | 252 | ||
| Limb Neuropathies | 252 | ||
| Mononeuropathy | 252 | ||
| Cranial Neuropathy | 252 | ||
| Multiple Neuropathies | 252 | ||
| Diagnosis of Diabetic Neuropathy | 253 | ||
| Nerve Conduction Studies | 253 | ||
| Uremic Neuropathy | 254 | ||
| Acute Intermittent Porphyria | 254 | ||
| Amyloidosis | 255 | ||
| Carcinomatous Neuropathy | 256 | ||
| Neuropathy Associated with Paraproteinemia | 256 | ||
| Nutritional Neuropathy | 257 | ||
| B-Complex Deficiency Neuropathy | 257 | ||
| Vitamin E Deficiency | 258 | ||
| Critical Care Neuropathy | 258 | ||
| Neurophysiological Findings | 259 | ||
| Toxic Neuropathy | 259 | ||
| Drug-Induced Neuropathy | 261 | ||
| Ischemic Neuropathy | 262 | ||
| Neuropathy Associated with Connective Tissue Disorder | 262 | ||
| Vasculitic Neuropathy | 263 | ||
| Necrotizing Vasculitis | 264 | ||
| Rheumatoid Arthritis | 265 | ||
| Distal Symmetrical Polyneuropathy | 265 | ||
| Compression Neuropathy | 265 | ||
| Trigeminal Neuropathy | 265 | ||
| Sensory Neuropathy | 266 | ||
| Overview of Investigations in Neuropathy | 266 | ||
| Chapter 6 - Repetitive Nerve Stimulation | 275 | ||
| Neuromuscular Junction | 275 | ||
| Physiology of Repetitive Nerve Stimulation Test | 277 | ||
| Variables Influencing Neuromuscular Transmission | 278 | ||
| Technique of RNS | 279 | ||
| Measurement | 280 | ||
| Interpretation of Repetitive Nerve Stimulation Test | 281 | ||
| Interpretation of RNS | 282 | ||
| Compound Muscle Action Potential | 282 | ||
| Low Rate Repetitive Nerve Stimulation | 283 | ||
| Effect of Exercise or Tetanic Stimulation | 283 | ||
| High Rate Repetitive Nerve Stimulation | 285 | ||
| Clinical Application of RNS Study | 285 | ||
| Myasthenia Gravis | 285 | ||
| Lambert-Eaton Myasthenic Syndrome | 288 | ||
| Overlap Myasthenic Syndrome | 290 | ||
| Congenital Myasthenic Syndrome | 290 | ||
| Botulism | 291 | ||
| Magnesium-Induced Myasthenia | 292 | ||
| Antibiotic-Induced Myasthenia | 292 | ||
| Organophosphate Toxicity | 292 | ||
| Arthropod and Snake-Bite | 293 | ||
| Suggested Electrodiagnostic Approach to A Patient with Neuromuscular Junction Disorder | 293 | ||
| Chapter 7 - Single Fiber Electromyography\r | 297 | ||
| Introduction | 297 | ||
| Method of Single Fiber Electromyography | 298 | ||
| Jitter | 298 | ||
| Jitter Analysis | 300 | ||
| Variables Affecting the Jitter | 300 | ||
| Temperature | 300 | ||
| Exercise | 300 | ||
| Recording site | 300 | ||
| Muscle studied | 300 | ||
| Ischemia | 300 | ||
| Age | 300 | ||
| Drugs | 300 | ||
| Jitter in Pathological Conditions | 300 | ||
| Blocking | 301 | ||
| Fiber Density | 302 | ||
| Duration of Single Fiber Potential | 303 | ||
| Propagation of Velocity | 303 | ||
| Single Fiber EMG in Neurologic Diseases | 303 | ||
| Neuromuscular Transmission Disorders | 303 | ||
| SFEMG in Neurogenic Disorders | 304 | ||
| Amyotrophic Lateral Sclerosis (ALS) | 305 | ||
| Progressive Muscular Atrophy | 305 | ||
| Poliomyelitis | 305 | ||
| Peripheral Neuropathy | 306 | ||
| SFEMG in Myopathies | 306 | ||
| Macro EMG | 307 | ||
| Chapter 8 - Visual Evoked Potential\r | 309 | ||
| Anatomical Basis of Visual Evoked Potential | 309 | ||
| Methods of Visual Evoked Potential | 311 | ||
| Pretest Evaluation | 311 | ||
| Running the Test | 311 | ||
| Partial Field Stimulation | 313 | ||
| Normal PSVEP | 314 | ||
| Variables Influencing VEP | 314 | ||
| Age | 314 | ||
| Gender | 314 | ||
| Eye Dominance | 315 | ||
| Eye Movement | 315 | ||
| Visual Acuity | 315 | ||
| Drugs | 315 | ||
| Reproducibility and Variability | 315 | ||
| Steady-State VEP | 316 | ||
| Basis of VEP Abnormalities | 316 | ||
| Clinical Applications of VEP | 316 | ||
| Demyelinating Diseases | 316 | ||
| Multiple Sclerosis | 316 | ||
| Optic Neuritis | 318 | ||
| Ischemic Optic Neuropathy | 319 | ||
| HIV Infection | 320 | ||
| Nutritional and Toxic Optic Neuropathy | 320 | ||
| Hereditary and Degenerative Diseases | 321 | ||
| Compressive Lesions Affecting Anterior Visual Pathways | 322 | ||
| VEP in Cortical Blindness | 322 | ||
| Malingering and Hysteria | 324 | ||
| Intraoperative Monitoring | 324 | ||
| Chapter 9 - Brainstem Auditory Evoked Potential\r | 329 | ||
| Anatomical and Physiological Basis of BAEPs | 329 | ||
| Brainstem Electrical Activity and Its Correlation with BAEP | 330 | ||
| Patient-Related Variables Affecting BAEP | 330 | ||
| Method | 331 | ||
| Recording Electrodes | 331 | ||
| Amplifier and Averager | 331 | ||
| Stimulation | 332 | ||
| Hearing Level (dB HL) | 333 | ||
| Sensory Level (dB SL) | 334 | ||
| Physical Definition (dB pe SPL) | 334 | ||
| Individual Equipment Scale | 334 | ||
| Normal Baep, Potential Field Distribution, Waveform Recognition, and Normal Values | 334 | ||
| Wave I | 334 | ||
| Wave II | 335 | ||
| Wave III | 335 | ||
| Wave IV and V | 335 | ||
| Measurement and Normal Values of BAEPs | 336 | ||
| Absolute Latencies and Amplitudes | 336 | ||
| Inter Peak Latency | 336 | ||
| I-V IPL | 336 | ||
| I-III IPL | 336 | ||
| III-V IPL | 336 | ||
| V/I Amplitude Ratio | 337 | ||
| Abnormal BAEP | 337 | ||
| Latency Intensity Slope | 337 | ||
| Clinical Neurophysiological Correlation | 337 | ||
| Cerebellopontine Angle Tumor | 338 | ||
| Intrinsic Brainstem Tumor | 339 | ||
| Multiple Sclerosis (MS) | 339 | ||
| Coma | 341 | ||
| Brain Death | 342 | ||
| Stroke | 344 | ||
| Miscellaneous | 344 | ||
| Chapter 10 - Somatosensory Evokedpotentials \r | 347 | ||
| ANATOMICAL AND PHYSIOLOGICALBASIS OF SEP | 347 | ||
| METHODS | 348 | ||
| PRETEST INSTRUCTIONS | 348 | ||
| MEDIAN SOMATOSENSORY EVOKED POTENTIAL | 348 | ||
| NORMAL MEDIAN SEP | 349 | ||
| IDENTIFICATION OF WAVEFORMS | 349 | ||
| GENERATORS OF MEDIAN SEP | 351 | ||
| TIBIAL SOMATOSENSORY EVOKED POTENTIALS | 352 | ||
| Normal Tibial SEP | 353 | ||
| Generators of Tibial SEP | 354 | ||
| REPRODUCIBILITY OF SOMATOSENSORYEVOKED POTENTIAL | 354 | ||
| PATIENT-RELATED FACTORS | 355 | ||
| CLINICAL APPLICATION OFSOMATOSENSORY EVOKED POTENTIAL | 355 | ||
| DEMYELINATING DISEASES | 356 | ||
| TRAUMA | 357 | ||
| VASCULAR LESIONS | 358 | ||
| INFECTIONS: ACUTE TRANSVERSE MYELITIS (ATM) | 360 | ||
| HTLV I AND HIV MYELOPATHY | 360 | ||
| POTT’S PARAPLEGIA | 361 | ||
| JAPANESE ENCEPHALITIS | 362 | ||
| SEPTIC ENCEPHALOPATHY | 362 | ||
| DEGENERATIVE DISEASES | 362 | ||
| Cervical Spondylosis | 362 | ||
| Lumbar Spondylosis | 363 | ||
| Hereditary Ataxia | 363 | ||
| Myoclonus | 364 | ||
| COMA AND BRAIN DEATH | 364 | ||
| NUTRITIONAL MYELOPATHY | 365 | ||
| SPINAL CORD TUMOR | 365 | ||
| SURGICAL MONITORING | 366 | ||
| Methods | 366 | ||
| Chapter 11 - Motor Evoked Potential \r | 373 | ||
| ANATOMY AND PHYSIOLOGY OFCORTICOSPINAL TRACT | 373 | ||
| PHYSIOLOGICAL BASIS OF MOTOREVOKED POTENTIAL | 374 | ||
| MAGNETIC STIMULATION | 377 | ||
| METHOD OF MOTOR EVOKEDPOTENTIAL | 377 | ||
| PRETEST INSTRUCTIONS | 377 | ||
| ELECTRODE PLACEMENT FOR ELECTRICAL STIMULATION | 377 | ||
| ELECTRODE PLACEMENT FOR MAGNETIC STIMULATION | 377 | ||
| RUNNING THE TEST | 379 | ||
| MEASUREMENT OF CMCT | 379 | ||
| AMPLITUDE AND MEP/CMAP RATIO | 380 | ||
| CMCT ABNORMALITIES ANDTHEIR BASIS | 381 | ||
| COMPARISON OF ELECTRICAL ANDMAGNETIC STIMULATION | 381 | ||
| SAFETY OF TRANSCRANIAL ELECTRICALAND MAGNETIC STIMULATION | 381 | ||
| CLINICAL APPLICATIONS | 382 | ||
| DEMYELINATING DISEASES | 382 | ||
| STROKE | 384 | ||
| DEGENERATIVE DISEASES | 387 | ||
| HEREDITARY ATAXIA | 389 | ||
| CERVICAL SPONDYLOSIS | 389 | ||
| INFLAMMATORY DISEASES | 391 | ||
| Acute Transverse Myelitis (ATM) | 391 | ||
| Encephalitis | 393 | ||
| Neurolathyrism | 394 | ||
| Vitamin B12 Myelopathy | 394 | ||
| Head Injury and Coma | 394 | ||
| Spinal Cord Injuries | 395 | ||
| MISCELLANEOUS DISEASES | 396 | ||
| Parkinson’s Disease | 396 | ||
| Chapter 12 - Cognitive Evoked Potential\r | 401 | ||
| P3 | 401 | ||
| Methods | 401 | ||
| Subject | 401 | ||
| Electrode Placement | 401 | ||
| Stimulus | 402 | ||
| Machine Setup and Running the Test | 402 | ||
| Waveform Identification and Measurement | 402 | ||
| Variables Affecting P3 | 403 | ||
| Attention | 403 | ||
| Task | 403 | ||
| Age | 403 | ||
| Drugs | 404 | ||
| Technical Parameters | 404 | ||
| Intraindividual Variability | 404 | ||
| Generators of P3 | 404 | ||
| Clinical Application | 404 | ||
| Aging | 404 | ||
| Dementia | 405 | ||
| Movement Disorders | 406 | ||
| HIV Infection | 407 | ||
| Psychiatric Disorders | 407 | ||
| Mental Retardation | 407 | ||
| Nutritional, Toxic, and Metabolic Disorders | 407 | ||
| Chapter 13 - Electrodiagnosis in Pediatric Practice\r | 411 | ||
| Nerve Conduction Studies (NCS) | 412 | ||
| Shock Artifact | 412 | ||
| Motor Nerve Conduction Studies | 413 | ||
| Maturation | 413 | ||
| F Latency | 415 | ||
| Sensory Nerve Conduction Studies | 415 | ||
| Needle Electromyography | 416 | ||
| Motor Unit Potentials | 418 | ||
| Repetitive Nerve Stimulation | 418 | ||
| Methodology | 419 | ||
| Visual Evoked Potential in Pediatric Practice | 419 | ||
| Maturation of VEP | 419 | ||
| Stroboscopic Flash VEP Maturation | 419 | ||
| Measurement of VEP | 420 | ||
| Clinical Application | 421 | ||
| Visual Acuity | 421 | ||
| Loss of Vision | 421 | ||
| Degenerative Diseases | 421 | ||
| Coma and Asphyxia | 421 | ||
| Electrode Placement | 423 | ||
| Brainstem Auditory Evoked Potential in Pediatric Practice | 423 | ||
| Machine Setup | 423 | ||
| Montage | 424 | ||
| Fetal Recording | 424 | ||
| Neonatal Hearing Screening | 426 | ||
| Evoked Potential Audiometry | 427 | ||
| Hyperbilirubinemia | 428 | ||
| Auditory Dyssynchrony (AD) | 428 | ||
| Hearing Impairment | 429 | ||
| Baep in Spastic Cerebral Palsy | 429 | ||
| Bacterial Meningitis | 429 | ||
| Posterior Fossa Tumors | 430 | ||
| Miscellaneous Disorders | 430 | ||
| Somatosensory Evoked Potentials in Pediatric Practice | 435 | ||
| Chapter 14 - Role of Clinical Neurophysiology in the Prognosis of Neuromuscular Disorders\r | 441 | ||
| Amyotrophic Lateral Sclerosis (ALS) | 441 | ||
| Radiculopathy | 442 | ||
| Traumatic Nerve Injury | 442 | ||
| Follow-up Studies | 443 | ||
| Polyneuropathy | 444 | ||
| Axonal Polyneuropathy | 444 | ||
| Guillain-Barré Syndrome | 444 | ||
| Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) | 446 | ||
| Entrapment Neuropathies | 446 | ||
| Facial Neuropathy | 446 | ||
| CMAP Amplitude | 446 | ||
| Latency of Facial CMAP | 447 | ||
| Needle Electromyography | 448 | ||
| Blink Reflex | 448 | ||
| Diseases of Neuromuscular Junction | 449 | ||
| Myasthenia Gravis (MG) | 449 | ||
| Single Fiber EMG | 449 | ||
| Lambert Eaton Myasthenic Syndrome (LEMS) | 449 | ||
| Myopathy | 450 | ||
| Inflammatory Myopathy | 450 | ||
| Muscular Dystrophy | 451 | ||
| Myotonic Dystrophy | 451 | ||
| Acute Transverse Myelitis (ATM) | 452 | ||
| Index\r | 457 | ||
| A | 457 | ||
| B | 457 | ||
| C | 458 | ||
| D | 458 | ||
| E | 458 | ||
| F | 459 | ||
| G | 460 | ||
| H | 460 | ||
| I | 460 | ||
| J | 460 | ||
| K | 460 | ||
| L | 460 | ||
| M | 460 | ||
| N | 461 | ||
| O | 461 | ||
| P | 462 | ||
| Q | 462 | ||
| R | 462 | ||
| S | 463 | ||
| T | 464 | ||
| U | 464 | ||
| V | 464 | ||
| W | 464 |