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9780444512529

Clinical Neurophysiology: EMG, Nerve Conduction and Evoked Potentials; Volume 1 (Revised and Enlarged Edition)

by
  • ISBN13:

    9780444512529

  • ISBN10:

    0444512527

  • Edition: Large
  • Format: Hardcover
  • Copyright: 2004-05-20
  • Publisher: Elsevier
  • Purchase Benefits
List Price: $395.00

Summary

This is part of a 2-volume work in which the authors treat the three main branches of clinical neurophysiology - peripheral neurophysiology, evoked potentials and electroencephalography - in a consistent and integrated way with emphasis on a clear exposition of practical details of how and why each investigation is done. Their aim is that the reader should understand exactly how to choose and to undertake appropriate investigations, and how to interpret the findings in the light of the latest evidence-based studies. Using historical evidence and illustrative case reports, they address the scientific principles, both biological and electrical, recording techniques, the development and characteristics of electrical potentials in normal subjects, and the ways in which these are disturbed by physical factors or disease. This foundation should enable the reader to interpret recordings from first principles. The main clinical sections are set in the context of typical referral problems or disease groups, showing how the appropriate sequence of investigations and their interpretation help in diagnosis or surveillance of the patient's condition.

Table of Contents

Editors and Contributors v
Preface to the 1995 Edition vii
Preface to the 2004 Edition ix
Acknowledgements xi
Abbreviations xiii
Part 1: Origins and Techniques
R. Cooper
Fundamentals of neurophysiology
3(16)
G. Alarcon
R. Cooper
C.D. Binnie
C.J. Fowler
Introduction
3(1)
The neurone
3(1)
Membranes and membrane potentials
4(4)
Structure
4(1)
Resting potential
4(1)
Action potentials
5(1)
Propagation along an axon
6(1)
Nerve conduction as communication engineering
7(1)
Electrical fields due to travelling action potentials
8(2)
Origins of cerebral electrical activity
10(3)
Microscopic structure of cortex
10(1)
Synaptic structure
11(1)
Excitation and inhibition
12(1)
Integration of synaptic activity
12(1)
Electrical activity of the brain
13(4)
The electroencephalogram
13(4)
Evoked potentials
17(1)
References
17(2)
Techniques
19(24)
R. Cooper
G. Alarcon
C.D. Binnie
Recording the electrical activities of the nervous system
19(15)
Signal bandwidth and filters
19(3)
Amplifiers
22(3)
Connections to amplifiers
25(3)
Digital systems
28(1)
Electrodes
29(3)
Ambulatory recording
32(1)
Electrical safety
33(1)
Recording evoked potentials
34(4)
Signal-to-noise improvement
34(1)
Superimposition
34(1)
Averaging
35(3)
Infection control
38(1)
References
39(4)
Part 2: Electromyography and Nerve Conduction
B.M. Tedman
Early history of nerve conduction studies and electromyography
43(6)
C.J. Fowler
B.M. Tedman
Introduction
43(2)
Lambert and collaborators at the Mayo Clinic
43(1)
The National Hospital, Queen Square
43(1)
Buchthal in Copenhagen
44(1)
Stalberg and colleagues in Uppsala
45(1)
EMG and the IFSECN
45(1)
Present-day electrodiagnostics
45(2)
Number of requests
45(1)
Types of referral
46(1)
References
47(2)
Anatomy and function of peripheral nerves
49(10)
C.J. Fowler
B.M. Tedman
Structure and function of the peripheral nervous system
49(4)
Peripheral nerves
49(2)
Afferent fibres
51(1)
The motor unit
52(1)
Neuromuscular junction structure and mechanisms of neuromuscular transmission
53(1)
Physiology of nerve conduction
53(3)
Cable properties of axons
53(1)
Conduction of action potentials
54(1)
Determinants of conduction velocity
54(1)
Fibre diameters in human nerve
55(1)
References
56(3)
Clinical measurements of nerve conduction
59(18)
C.J. Fowler
B.M. Tedman
Introduction
59(8)
Compound nerve action potentials
59(1)
Sensory action potentials
60(2)
Compound muscle action potentials
62(1)
Motor conduction velocity
63(1)
F waves
64(2)
H reflex
66(1)
Pathophysiological changes in nerve conduction
67(4)
Axonal degeneration
67(1)
Demyelination
68(3)
Reinnervation
71(1)
Limitations of nerve conduction studies
71(2)
Spectrum of fibres examined using clinical electrophysiological techniques
71(1)
Lack of correlation between disability and nerve conduction abnormality
72(1)
References
73(4)
Electromyography: normal and pathological findings
77(30)
C.J. Fowler
B.M. Tedman
Introduction
77(1)
Physiology of motor units
77(3)
The motor unit
77(1)
Arrangement of muscle fibres within the motor unit
77(1)
Innervation ratio
78(1)
Number of motor units per muscle
79(1)
Types of motor unit
79(1)
Recruitment of motor units
79(1)
Features of motor units recorded by needle electrodes
80(4)
Characteristics of motor units recorded with a concentric needle electrode
80(3)
Interference pattern or pattern on volitional effort
83(1)
Other normal EMG phenomena
83(1)
EMG in disease states
84(9)
Abnormal EMG activity at rest
84(6)
Changes in motor unit configuration with reinnervation
90(1)
Changes in motor units with primary muscle disease
91(1)
Summary of the EMG features of pathological conditions
92(1)
Clinical questions that may be answered by EMG
92(1)
Automated EMG analysis
93(2)
Automated analysis of motor units
93(1)
Willison's turns/amplitude analysis
94(1)
How to perform CNE EMG examination of a muscle
95(2)
Stages of EMG examination
95(1)
Practical points when performing EMG
96(1)
Possible hazards when performing EMG
96(1)
Single fibre EMG
97(5)
Single fibre needle electrode
97(1)
Instrumental requirements for single fibre EMG
98(1)
Practical procedure for single fibre EMG
98(1)
Fibre density
99(1)
Jitter
100(1)
Performing jitter analysis
101(1)
Methods of analysis of single fibre data
101(1)
References
102(5)
Nerve conduction studies and EMG sampling
107(36)
C.J. Fowler
B.M. Tedman
General considerations
107(4)
Care of the patient
107(1)
Procedure for stimulation
107(1)
EMG sampling
107(1)
Practical difficulties that can affect nerve conduction studies
108(1)
Effects of limb temperature
108(2)
Effects of age and gender
110(1)
Instrumentation and electrodes for recording
111(2)
Amplifiers
111(1)
Display
112(1)
Stimulation
112(1)
Electrodes
112(1)
Conduction studies of individual nerves
113(27)
Introduction
113(1)
Facial nerve
113(1)
Accessory nerve
114(1)
Brachial plexus
115(3)
Median nerve
118(4)
Ulnar nerve
122(3)
Radial nerve
125(3)
Lumbosacral plexus
128(3)
Sciatic nerve
131(1)
Common peroneal nerve
132(4)
Tibial nerve
136(2)
Sural nerve
138(2)
References
140(3)
Specific clinical requests
143(116)
B.M. Tedman
C.J. Fowler
A. Mallik
D.G. Thompson
Introduction
143(1)
Electrodiagnostic features of peripheral neuropathy
143(19)
Introduction
143(1)
Neurophysiological examination
144(2)
Types of neuropathy
146(16)
Is there EMG evidence of a myopathy?
162(11)
Introduction
162(1)
Pathological changes in myopathy
162(1)
EMG findings in myopathy
162(3)
Causes of myopathy
165(1)
Acquired myopathies
165(3)
Genetically determined myopathies
168(5)
Does the patient have motor neurone disease?
173(7)
Introduction
173(1)
Electrophysiological findings in MND
174(4)
Differential diagnosis
178(2)
Facial palsy
180(4)
Introduction
180(1)
Causes of lower motor neurone facial weakness
180(2)
Neurophysiological assessment of facial palsy
182(1)
Strategy for neurophysiological investigation of facial palsy
183(1)
Causes of proximal weakness
184(6)
Introduction
184(1)
Myopathic weakness
185(1)
Neuromuscular blocking disorders
185(1)
Neurogenic causes of proximal weakness
186(4)
Other causes of proximal weakness
190(1)
Weakness and wasting of hand muscles
190(9)
Introduction
190(1)
Weakness of the intrinsic muscles sparing the thenar eminence
191(3)
Wasting of the thenar eminence
194(1)
Wasting of all intrinsic hand muscles
195(2)
Weakness of the hand and wrist
197(2)
Pain and other sensory symptoms in the arm and hand
199(10)
Introduction
199(1)
Carpal tunnel syndrome
199(6)
Ulnar nerve entrapment
205(1)
Brachial plexus lesions
205(1)
Cervical radiculopathy
205(3)
Other causes of pain in the arm and hand
208(1)
Fatigue
209(6)
Introduction
209(1)
Myasthenia gravis
210(1)
Neurophysiological findings in myasthenia gravis
211(3)
Lambert--Eaton syndrome or myasthenic syndrome
214(1)
Botulism
214(1)
Other causes of fatigue
215(1)
Myalgic encephalomyelitis
215(1)
Foot drop
215(4)
Introduction
215(1)
Common peroneal nerve palsy
216(1)
L5/S1 root lesion
217(1)
Other causes of foot drop
217(1)
Strategy for neurophysiological investigation
218(1)
Pain in the lower back and leg
219(4)
Introduction
219(1)
Lumbo-sacral radiculopathy
219(4)
Lumbo-sacral plexopathy
223(1)
Electrophysiological differentiation between suspected root and plexus lesions
223(1)
Painful feet
223(4)
Introduction
223(1)
Tarsal tunnel syndrome
223(1)
Morton's metatarsalgia
224(1)
Painful small-fibre peripheral neuropathy
225(1)
Painful burning feet without evidence of small-fibre neuropathy
225(1)
Orthopaedic causes of painful feet
226(1)
Strategy for electrodiagnostic testing
226(1)
Peripheral nerve injuries in sport
227(9)
Introduction
227(1)
Specific nerve injuries
228(1)
Range of peripheral nerve injuries encountered in sport
229(6)
Approach to neurophysiological investigation of sports injuries
235(1)
EMG changes associated with training
235(1)
References
236(23)
Assessment of autonomic function
259(22)
C.J. Mathias
Introduction and basic principles
259(1)
Classification of autonomic disorders
260(1)
Clinical manifestations in autonomic disorders
261(1)
Investigation of autonomic function
261(17)
Cardiovascular system
262(11)
Intraneural recordings of sympathetic activity
273(1)
Sudomotor system and thermoregulation
274(2)
The eye
276(1)
Gastrointestinal tract
276(1)
Renal function and urinary tract
276(1)
Genital tract
277(1)
Respiratory tract
277(1)
Miscellaneous investigations
277(1)
Concluding remarks
278(1)
Additional reading
278(1)
References
278(3)
Pelvic floor clinical neurophysiology
281(28)
D.B. Vodusek
C.J. Fowler
Introduction
281(1)
Somatic sacral motor system tests
281(16)
Electromyography (EMG)
281(7)
EMG in clinical disorders
288(3)
Pudendal nerve conduction tests
291(1)
Anterior sacral root (cauda equina) stimulation
292(1)
Sensory testing
293(1)
Quantitative sensory testing
294(1)
Sensory neurography
295(2)
Sacral reflexes
297(2)
Sacral reflex on electrical stimulation
298(1)
Sacral reflex on mechanical stimulation
299(1)
Autonomic nervous system tests
299(1)
Tests in generalised autonomic neuropathy
299(1)
Smooth muscle electromyography
299(1)
Sympathetic skin response (SSR)
299(1)
Usefulness of clinical neurophysiological tests in uroneurological research
300(1)
Evaluation of individual patients with sacral dysfunction
300(1)
Appendix: Recommendation for technical standards
301(1)
References
301(8)
Quantitative sensory testing
309(28)
D. Yarnitsky
D. Pud
The need for quantification of sensation
309(1)
Controversies in sensory physiology
309(1)
Range of fibres examined by quantification of sensation
310(3)
Conduction velocity of afferents subserving light touch and vibration
310(2)
Conduction velocity of afferents subserving thermal sensation
312(1)
Which sensory modalities to test in the assessment of peripheral neuropathy
312(1)
Conduction velocity of afferents which convey pain
312(1)
Quantification of sensation
313(3)
Psychophysical thresholds
313(1)
Methods for threshold measurement
313(2)
Magnitude estimation of suprathreshold sensations
315(1)
Temporal summation
316(1)
Equipment
316(3)
Thermal sensation
316(1)
Light touch
317(1)
Vibration
317(1)
Perception of electrical current
318(1)
Pain
318(1)
Control ranges and reproducibility of threshold measurements
319(3)
Control range
319(2)
Test-retest reproducibility
321(1)
Value judgement of thresholds
321(1)
QST and gender
321(1)
Clinical applications
322(8)
Disorders of the peripheral nervous system
322(4)
Disorders of the central nervous system
326(1)
Disorders with pain as a major manifestation
327(3)
Concluding remarks
330(1)
References
330(7)
Single fibre electromyography
337(6)
E. Stalberg
Introduction
337(1)
Technical aspects
337(1)
Single fibre action potential
337(1)
SFEMG parameters
337(1)
SFEMG during voluntary muscle activation
337(2)
Introduction
337(1)
Jitter
338(1)
Fibre density
339(1)
SFEMG during electrical stimulation
339(1)
Introduction
339(1)
Technique
339(1)
Analysis of jitter
340(1)
Clinical aspects of SFEMG
340(1)
Practical comments
341(1)
References
341(2)
Analysis of electromyographic activity
343(14)
S. Stalberg
E. Stalberg
Introduction
343(1)
Analysis of the EMG at rest
343(1)
EMG with slight or moderate activity
344(2)
The motor unit potential
344(1)
Analysis of the MUP
345(1)
EMG with increasing voluntary contraction
346(1)
EMG pattern with strong contraction
347(4)
Frequency analysis
347(1)
Time domain analysis; turns/amplitude analysis
348(3)
Combination of methods
351(1)
Surface EMG
352(1)
Polygraphy
352(1)
Multi-array surface electrode EMG
352(1)
Expert systems
352(1)
References
353(4)
Part 3: Evoked Potentials
F. Mauguiere
Definitions and introductory remarks
357(10)
F. Mauguiere
General definition -- limitations -- clinical utility of evoked potentials
357(1)
Responses and EP components
358(1)
Sensory, cognitive and premotor EP components
359(1)
Relation between neuronal responses and surface EPs
359(2)
Action potentials
360(1)
Postsynaptic potentials
360(1)
The electroretinogram
361(1)
The electrocochleogram
361(1)
The concept of the EP generator
361(1)
Near-field versus far-field EPs
362(1)
How to localise EP sources from surface recordings
363(3)
References
366(1)
Methods and instrumentation
367(14)
R. Cooper
F. Mauguiere
Basic instrumentation for data acquisition
367(1)
Amplifiers
367(1)
Filters
367(1)
Electrodes
367(1)
Averaging
367(1)
Calibration
368(1)
Stimulators
368(1)
Display
368(1)
Stimulation
368(8)
Visual stimulation
368(3)
Auditory stimulation
371(2)
Somatosensory stimulation
373(1)
Multimodal stimulation
374(1)
Maximum length sequences
374(1)
Transcutaneous stimulation of the motor cortex
374(2)
Pain stimulation
376(1)
Chemosensory stimulation
376(1)
Polarity and nomenclature of EP components
376(1)
References
377(4)
Recording procedures
381(22)
F. Mauguiere
B. Ceranic
R. Cooper
G.E. Holder
L.M. Luxon
Electroretinography and visual evoked potentials
381(7)
Electroretinography
381(4)
Visual evoked potentials
385(3)
Electrocochleography and auditory evoked potentials
388(7)
Electrocochleography
388(3)
Brainstem auditory evoked potentials
391(1)
Middle latency auditory evoked potentials
392(2)
Long latency auditory evoked potentials
394(1)
Somatosensory evoked potentials
395(3)
Analysis time and sampling rates
395(1)
Filters
395(1)
Sensitivity and number of sweeps
395(1)
Electrode placement and montages
396(1)
Placement of the ground electrode
396(1)
Upper limb SEPs
396(1)
Lower limb and pudendal SEPs
397(1)
Concluding remarks
397(1)
Event-related potentials
398(1)
References
399(4)
Normal findings by modality
403(84)
F. Mauguiere
S.R. Butler
B. Ceranic
R. Cooper
G.E. Holder
L.M. Luxon
Electroretinography and visual evoked potentials
403(12)
Electroretinography
403(2)
Visual evoked potentials
405(10)
Electrocochleography and auditory evoked potentials
415(14)
Electrocochleography
415(3)
Brainstem auditory evoked potentials
418(4)
Middle latency auditory evoked potentials
422(4)
Long latency auditory evoked potentials
426(3)
Somatosensory evoked potentials
429(34)
Fibre tracts involved in the genesis of SEPs
429(2)
Description and origins of SEP components
431(32)
Event-related and cognitive potentials
463(7)
Event-related potentials
463(1)
N1--P2 complex
464(2)
N2, P3 and slow wave components
466(1)
Contingent negative variation
466(1)
Bereitschaftspotential
467(1)
Mismatch negativity
468(2)
Transcutaneous stimulation of brain, spinal cord and roots
470(2)
Physiological aspects
470(1)
Normal findings
471(1)
Magnetic stimulation of peripheral nerves and roots
472(1)
References
472(15)
Abnormal waveforms and diagnostic yield of evoked potentials
487(62)
F. Mauguiere
B. Ceranic
R. Cooper
G.E. Holder
L.M. Luxon
R.C. Pottinger
Electroretinography and visual evoked potentials
487(20)
Clinical ERG
487(3)
Clinical PERG
490(7)
Concluding ERG remarks
497(1)
Abnormal flash VEPs
497(1)
Abnormal pattern-reversal VEPs
497(10)
Electrocochleography and auditory evoked potentials
507(7)
Electrocochleography
507(2)
Brainstem auditory evoked potentials
509(4)
Middle latency auditory evoked potentials
513(1)
Long latency auditory evoked potentials
514(1)
Somatosensory evoked potentials
514(25)
Peripheral lesions
515(4)
Combined involvement of peripheral nerve and spinal cord in hereditary ataxias
519(1)
Spinal cord lesions
520(6)
Lesions of the cervico-medullary junction
526(1)
Brainstem lesions
527(1)
Thalamic and capsulo-thalamic lesions
528(2)
Cortical lesions
530(1)
Clinical relevance of the dissociated loss of parietal or frontal SEPs in hemispheric lesions
531(1)
Giant SEPs
532(2)
SEPs in central demyelination
534(5)
References
539(10)
Evoked potential diagnostic strategies
549(56)
F. Mauguiere
L. Garcia-Larrea
T.D. Rogers
Assessment of silent demyelinating lesions in multiple sclerosis
549(9)
Abnormal EP patterns in MS
549(3)
Diagnostic yield of EPs in MS patients
552(5)
Predictive value of EP abnormalities
557(1)
EP monitoring of the course of multiple sclerosis
558(1)
EPs in coma
558(13)
Introduction
558(1)
Non-pathological causes of EP abnormalities
559(1)
Clinical use of EPs during coma
560(9)
EPs in comatose or pseudocomatose states caused by primary brainstem lesions
569(1)
EPs in brain death
570(1)
Clinical applications of transcutaneous stimulation of brain, spinal cord and roots
571(1)
Clinical studies of central motor conduction
571(1)
Motor pathway monitoring during surgery
572(1)
SEP investigation of myoclonus and movement disorders
572(3)
Utility of electrophysiological data for the classification of myoclonic syndromes
572(1)
Clinical syndromes associated with giant SEPs
573(1)
Parkinson's disease
573(1)
Dystonia
574(1)
Huntington's disease
575(1)
EP exploration of pain syndromes
575(3)
Introductory remarks
575(1)
Radicular and spinal pain
576(1)
Trigeminal neuralgia
576(1)
Thalamic pain
577(1)
Neurosurgical treatment of chronic pain
577(1)
Grading of dementia
578(2)
Effect of normal ageing on EPs
578(2)
Cognitive slow potentials in psychiatry
580(2)
Introduction
580(1)
Schizophrenia
580(1)
Mood disorders
581(1)
Other psychiatric disorders
581(1)
EP testing in neuropsychology
582(2)
General remarks
582(1)
VEPs in cortical blindness
582(1)
SEPs in astereognosis
583(1)
Auditory defects in hemispheric lesions
584(1)
EPs in systemic disorders and internal medicine
584(7)
Hypothyroidism
586(2)
Renal failure
588(1)
Vitamin deficiencies
588(2)
AIDS and lymphotrophic virus infection
590(1)
Sudden infant death syndrome and sleep apnoea
590(1)
Ethambutol therapy
590(1)
Anti-convulsant drugs
590(1)
Alcoholism
591(1)
Fictitious blindness, deafness and hemianaesthesia
591(1)
References
592(13)
Analysis of evoked potentials
605(10)
R. Cooper
Introduction
605(1)
Variability of evoked potentials
605(3)
Amplitude
605(1)
Latency
606(2)
Fourier analysis
608(1)
Filtration
608(1)
Wiener filtering
608(1)
Harmonic analysis of stationary responses
608(1)
Principal component analysis
608(4)
Dipole models of cortical generators of evoked potentials
612(1)
Lissajous' trajectory of evoked potentials
613(1)
References
613(2)
Subject Index 615

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