Clinical Neurophysiology

1 History of Clinical Neurophysiology

Classic Electrodiagnosis

Electromyography and Nerve Stimulation

Technique

Evoked Potentials

Miscellaneous

2 An Introduction to Electrodiagnostic Signals and Their Measurements

Biophysics

Electrodes

Filter

Amplifi er

Averager

Display

Gain and Sweep Time

Signal Trigger and Delay Line

Stimulator

Referral Process

3 Nerve Conduction Study

3.1 PRINCIPLES OF NERVE CONDUCTION STUDY

Anatomy and Physiology

Axonal Transport

Impulse Propagation

Principles of Motor Nerve Conduction

Principles of Sensory Nerve Conduction

Variables Aff ecting the Nerve Conduction Study

3.2 MEDIAN NERVE

Anatomy

Nerve Conduction Study

Median Nerve Entrapment Syndromes

3.3 ULNAR NERVE

Anatomy

Nerve Conduction Study

Ulnar Neuropathy

3.4 RADIAL NERVE

Anatomy

Nerve Conduction Study

Radial Neuropathy

3.5 BRACHIAL PLEXUS

Anatomy

Brachial Plexopathy

Neurophysiological Assessment of Brachial Plexus Lesions

Thoracic Outlet Obstruction

Brachial Neuritis

Radiation-Induced Plexopathy

Obstetric Brachial Plexopathy

3.6 CERVICAL RADICULOPATHY

Anatomy

Motor and Sensory Nerve Conduction

F Wave

Somatosensory Evoked Potentials

Nerve Root Stimulation

Needle Electromyography

Cervical Radiculopathy

3.7 LUMBAR PLEXUS AND ITS TERMINAL BRANCHES

Anatomy

Lumbosacral Plexopathy

Neurophysiological Evaluation

3.8 SACRAL PLEXUS AND ITS TERMINAL NERVE BRANCHES

Anatomy

3.9 LUMBOSACRAL RADICULOPATHY

Anatomy

L2, L3, and L4 Radiculopathies

L5 Radiculopathy

S1 and S2 Radiculopathy

Multiple Lumbosacral Radiculopathies

Diagnostic Utility of EMG and MRI in Radiculopathy

3.10 ANOMALOUS INNERVATION OF THE EXTREMITIES

Median to Ulnar Nerve Communication (Martin–Gruber Anastomosis)

Ulnar to Median Nerve Communication

Variations in the Innervations of Intrinsic Hand Muscles

Accessory Deep Peroneal Nerve

Tibial and Peroneal Nerve Communication

3.11 NERVE CONDUCTION OF NONLIMB NERVES

Phrenic Nerve

Facial Nerve

Hypoglossal Nerve

Great Auricular Nerve

3.12 LATE RESPONSE

H Refl ex

F Wave

Axon Refl ex

3.13 AUTONOMIC NERVOUS SYSTEM TESTING

Anatomical and Functional Basis

Autonomic Function Tests

4 Electromyography

4.1 INTRODUCTION TO ELECTROMYOGRAPHY

Anatomy of Muscle

Types of EMG Needle Electrodes

Recording Technique

4.2 TECHNIQUE OF ELECTROMYOGRAPHY

Muscles of Hands

Muscles of Forearm

Muscles of Arm

Muscles of Shoulder Girdle and Trunk

Muscle of Foot

Muscles of Leg

Muscles of Thigh

Muscles of Pelvic Girdle

Muscles of Face, Head, and Neck

Video 4.1 Insertional activity

Video 4.2 Positive sharp waves and fi brillations

Video 4.3 Myotonic discharges

Video 4.4 Complex repetitive discharge (CRD)

Video 4.5 Fibrillations and fasciculations

Video 4.6 Myopathic motor unit potentials

Video 4.7 Neurogenic motor unit potentials

5 Clinical Application of EMG and Nerve Conduction

5.1 ELECTROMYOGRAPHIC FINDINGS IN NEUROLOGICAL DISORDERS

Neurogenic Disorders

Myopathic Disorders

5.2 NERVE CONDUCTION AND EMG STUDIES IN POLYNEUROPATHIES

Pathophysiological Basis of Nerve Conduction Study

Conduction Block and Temporal Dispersion

Neurophysiological Classifi cation of Polyneuropathy

Limitation of Nerve Conduction Studies

Hereditary Neuropathies

Acute Infl ammatory Demyelinating Polyneuropathy

Chronic Infl ammatory Demyelinating Polyneuropathy

Subacute Idiopathic Demyelinating Polyradiculoneuropathy

Motor Neuropathy with Multifocal Conduction Block or Multifocal Motor Neuropathy

Neuropathy Associated with AIDS

Leprosy

Diphtheritic Neuropathy

Metabolic Neuropathy

Carcinomatous Neuropathy

Nutritional Neuropathy

Critical Care Neuropathy

Toxic Neuropathy

Drug-Induced Neuropathy

Ischemic Neuropathy

Neuropathy Associated with Connective Tissue Disorder

Overview of Investigations in Neuropathy

6 Repetitive Nerve Stimulation

Neuromuscular Junction

Physiology of RNS Test

Variables Infl uencing Neuromuscular Transmission

Technique of RNS

Measurement

Interpretation of RNS Test

Clinical Application of RNS Study

7 Single-Fiber Electromyography

Introduction

Method of SFEMG

SFEMG in Neurologic Diseases

Neuromuscular Transmission Disorders

SFEMG in Neurogenic Disorders

SFEMG in Myopathies

Macro-EMG

8 Visual Evoked Potential

Anatomical Basis of VEP

Methods of Visual Evoked Potential

Variables Infl uencing VEP

Clinical Applications of VEP

9 Brainstem Auditory Evoked Potential

Anatomical and Physiological Basis of BAEPs

Brainstem Electrical Activity and Its Correlation with BAEP

Patient-Related Variables Aff ecting BAEP

Method

Normal BAEP, Potential Field Distribution, Waveform Recognition, and Normal Values

Abnormal BAEP

Clinical Neurophysiological Correlation

10 Somatosensory Evoked Potentials

Anatomical and Physiological Basis of SEP Methods

Normal Median SEP

Tibial SEPs

Reproducibility of SEP

Patient-Related Factors

Clinical Application of SEP

Surgical Monitoring

11 Motor Evoked Potential

Anatomy and Physiology of Corticospinal Tract

Physiological Basis of Motor Evoked Potential

Method of Motor Evoked Potential

Measurement of CMCT

CMCT Abnormalities and Their Basis

Comparison of Electrical and Magnetic Stimulation

Safety of Transcranial Electrical and Magnetic Stimulation

Clinical Applications

12 Cognitive Evoked Potential

P3

Waveform Identifi cation and Measurement

Variables Aff ecting P3

Generators of P3

Clinical Application

13 Electrodiagnosis in Pediatric Practice

13.1 NERVE CONDUCTION AND ELECTROMYOGRAPHY

Nerve Conduction Studies

Sensory NCS

Needle EMG

Repetitive Nerve Stimulation

13.2 VISUAL EVOKED POTENTIAL IN PEDIATRIC PRACTICE

Methodology

Maturation of VEP

Measurement of VEP

Clinical Application

13.3 BRAINSTEM AUDITORY EVOKED POTENTIAL IN PEDIATRIC PRACTICE

Methodological Considerations

Maturation of BAEP

Clinical Application of BAEP in Pediatrics

13.4 SOMATOSENSORY EVOKED POTENTIALS IN PEDIATRIC PRACTICE

Methodological Considerations

Maturational Changes

Clinical Applications

14 Role of Clinical Neurophysiology in the Prognosis of Neuromuscular Disorders

Amyotrophic Lateral Sclerosis

Radiculopathy

Traumatic Nerve Injury

Polyneuropathy

Diseases of Neuromuscular Junction

Myopathy

Index