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PubMed2001

The clinical value of ophthalmic electrodiagnosis in children.

A group of 113 children with poor vision who had been referred to the Electrodiagnostic Clinic over a five year period were investigated for disease of the retina and optic pathway by electroretinography (ERG), electro-oculography (EOG) and visual evoked response (VER). The electrodiagnostic measurements were made using an automated system developed at Christchurch Hospital. The results of these investigations confirmed the clinical value of ophthalmic electrodiagnosis both as an aid in the diagnosis of these young patients and in determining their prognosis. In some cases it permitted an early detection of their condition. In addition the analyses of the ERG into rod and cone mediated responses helped to establish the diagnosis of hereditary retinal disorders and was particularly useful in the case of infants with nystagmoid movements of the eyes who were suspected of having poor vision. Interestingly 21 of the 113 patients were found to have functional visual loss. These patients complained of visual loss but subsequent examinations revealed their ocular findings, EOG, ERG and VER were all normal. The age of this functional visual loss group ranged from 7 to 15 years, with the average being 11.3 years (SD = 2.6 years). Furthermore they were a large group representing 32% of all the children between 7 and 15 years and in most cases were not happy at school.

Adolescent↗

PubMed1992

Electrodiagnosis of Martin-Gruber connection and its clinical importance in peripheral nerve surgery.

We propose new criteria for the electrodiagnosis of Martin-Gruber connection. Forty-seven patients with cubital tunnel syndrome were studied, and 8 (17%) were found to have a Martin-Gruber connection. Eighty-seven patients without cubital tunnel syndrome were also studied, and 14 (16%) had a Martin-Gruber connection. The rate of occurrence of the anastomosis in these two groups was approximately the same. No sensory communication was demonstrated, and the lateral intrinsic muscles received more innervation from the communicating branch than the hypothenar muscles. The entry point of the crossing fiber from the median nerve to the ulnar nerve was 3 to 10 cm distal to the medial humeral epicondyle, and there may be a significant risk of injury in ulnar nerve transposition.

Adult↗

PubMed2001

Medical technology assessment. Electrodiagnosis in motor neuron diseases and amyotrophic lateral sclerosis.

In motor neuron diseases/amyotrophic lateral sclerosis (MND-ALS), electrodiagnostic techniques are essential in supporting the diagnosis and excluding other conditions that clinically resemble MND-ALS. Electrodiagnostic techniques can also monitor disease progression and provide prognostic information. Electromyography has an important role in the diagnosis of MND-ALS, but some drawbacks should be borne in mind. Although internationally accepted electrophysiological criteria have been defined to support MND-ALS diagnosis, differences in different laboratories can raise unexpected difficulties in application of diagnosis criteria. Much work needs to be done to increase standardisation of the electrodiagnosis of MND-ALS in order to improve quality. Differential diagnosis with motor axonal neuropathies may be particularly difficult. EMG is an essential tool for the early diagnosis of MND-ALS, which increases potential benefit of therapeutic interventions. A wide discussion among neurophysiologists from different schools could create a sound consensus on early diagnosis of MND-ALS.

Amyotrophic Lateral Sclerosis↗

PubMedDate not supplied

Acute sensory neuronopathy: identified with electrodiagnosis and magnetic resonance imaging.

We report on a 13-year-old female with idiopathic acute sensory neuronopathy mimicking a sensory form of Guillain-Barré syndrome, which was identified by using electrodiagnosis and spine magnetic resonance imaging. Motor conduction results were normal, but no sensory nerve action potentials were seen in the four limbs. On magnetic resonance imaging of the whole spine, the diffuse gadolinium enhancement of the dorsal roots in the spinal canal was detected, without evidence of intramedullary lesions. The clinical symptoms and electrodiagnostic findings had persisted for more than 18 months of follow-up.

Adolescent↗

PubMedDate not supplied

Lateral femoral cutaneous nerve conduction v somatosensory evoked potentials for electrodiagnosis of meralgia paresthetica.

The aim of this study is to compare sensory nerve conduction with somatosensory evoked potentials of the lateral femoral cutaneous nerve to determine which is the most reliable electrodiagnostic method to assess meralgia paresthetica. Thirty patients with unilateral clinically defined meralgia paresthetica and 30 controls were studied with both methods. The main outcome measures were sensory action potential side-to-side amplitude ratio, somatosensory evoked potentials side-to-side latency difference, and side-to-side amplitude ratio. Sensory nerve conduction was abnormal in all patients: only four participants had abnormal somatosensory evoked potentials with double derivation (Fz/Cz and Ci/Cc) recording, and eight participants had abnormal findings with Fz/Cz derivation. Overall, this study demonstrates that sensory nerve conduction is the more reliable method for meralgia paresthetica electrodiagnosis. In fact, only very serious nerve damage regularly induces abnormal somatosensory evoked potentials, which is not recommended for routine electrodiagnostic study of meralgia paresthetica.

Adult↗

PubMed1993

A preoperative and postoperative study of the accuracy and value of electrodiagnosis in patients with lumbosacral disc herniation.

Twenty patients with a radicular syndrome, who underwent surgery for unilevel lumbosacral disc herniations verified by computed tomography were investigated with neurophysiologic tests (electromyograms, F-responses, dermatome somatosensory evoked potentials) preoperatively and 1 year postoperatively. At least one test revealed a pathologic abnormality preoperatively in 13 patients, but in 5 patients only the nerve root level corresponded to computed tomographic findings. Discordance between neurophysiologic and radiologic findings did not predict a surgical success rate. if all neurophysiologic tests were normal the outcome was significantly worse than if any of the tests showed an abnormality (P < 0.01). Four patients who were improved after surgery still had abnormal neurophysiologic findings. In conclusion, neurophysiology is not useful to diagnose the exact level of a nerve root lesion, but may reveal whether it is present. Electrodiagnosis is recommended if radiology and clinical testing conflict. If positive, it may then serve to justify surgical exploration.

Adult↗

PubMed2005

Clinical electromyography and electrodiagnosis course at Keio University Hospital--a 7-year experience.

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.

Diagnostic Techniques, Neurological↗

PubMed2000

Neuromuscular rehabilitation and electrodiagnosis. 4. Specialized neuropathy.

This self-directed learning module briefly highlights the differential diagnosis for acute weakness in patients with acute respiratory failure requiring prolonged mechanical ventilation. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article includes a discussion on the role of exercise in the treatment of patients with the late effects of poliomyelitis or with acute inflammatory demyelinating polyradiculoneuropathy.

Acute Disease↗

PubMed2004

[Electrodiagnosis, EMG, ENMG...: what do the future and the past tell us about the present?].

Neuromuscular imagery (NMI) of the future significantly extends the possibilities of nerve and muscle disorders investigation. It emphasizes some technical limitations inherent to electroneuromyography (ENMG) at the beginning of the 21st century, but also shows some progress that could have already been made to improve the quality of examination, as well as its comfort. In return, the history of these techniques points out a misunderstanding, by which electrodiagnosis and functional NMI have been asked to show morphological lesions, whereas their basic role is to highlight functional abnormalities that could account for patient complaints. Analysis of some frequent misinterpretations indicates that the functional point of view of ENMG and NMI requires to follow a suitable terminology, related to the anatomo-clinic one, but distinct from it. On the other hand, the example of purely functional abnormalities, like neuromuscular block, nerve conduction block and muscle excitability block, suggests that all electrophysiological abnormalities should be understood as membrane dysfunctions, before wondering whether they occur alone or accompanied with histological lesions. According to this specific point of view, the missions of present ENMG and future NMI are firstly to give patients an explanation of their complaints in terms of functional abnormalities, and secondly to try to bind these abnormalities to pathophysiological mechanisms defined at an anatomic level or at a molecular level.

Diagnostic Techniques, Neurological↗

PubMedDate not supplied

Utility (or futility?) of electrodiagnosis in thoracic outlet syndrome.

The objective diagnosis of thoracic outlet syndrome (TOS) remains a challenge. The purpose was to present our experience and discuss the utility of electromyography, electroneurography and somatosensory evoked potentials after ulnar nerve stimulation in patients with surgically verified neurovascular compression at the thoracic outlet. Twenty patients (median age 29.5, 16 women) with operatively verified neurovascular compression by a cervical rib or band were examined. All complained of pain and paraesthesias in the hand. In 12 vasomotor disturbances (pallor or lividity, low skin temperature, Raynaud's phenomenon) were also observed. Clinical diagnosis was supported by the provocative tests (Adson, Wright, costoclavicular) in 14persons. Neurologic signs were present in 2 patients in "pseudoulnar" distribution. Anterior scalenectomy was performed with success in 15 cases, 4 remained unchanged and 1 worsened. Electrodiagnostic tests were normal in all 18 patients without neurologic signs. We note a tendency for the digital nerves sensory action potentials in patients with TOS to be higher than usual It is concluded that electrodiagnosis is useless in confirming the presence of TOS, but it is very useful to exclude other painful conditions that require other treatments (carpal and cubital tunnel syndromes, cervical radiculopathies etc).

Adult↗

PubMed1984

Recent developments in the electrodiagnosis of radiculopathies.

The accuracy and reliability of electrodiagnosis in radiculopathy has improved in recent years. A better understanding of EMG findings coupled with the development of several tests that have recently become available in clinical practice (F wave studies, H reflex studies, and somatosensory evoked potential studies) have made it a valuable tool in the complete work-up for suspected radiculopathy. The use of this technique is reviewed and an illustrative case report is presented.

Adult↗

PubMed1963