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Neuromuscular Electrodiagnostics
The function of the neuromuscular systems depends upon transient electrical signals emerging from nerve cells and highly localized synaptic sites and the interactivity of nerve - muscle connections and control mechanisms. Command and control signals are generated by voltage-gated ion channels in excitable membranes and ligand-operated synaptic receptors, which are the fundamental signalling units of the nervous communications network. Via ascending and descending pathways in the spinal cord , the brain oversees and controls all voluntary and co-directs a large component of involuntary activity in the human body.
Neuroelectrodiagnostic services are a sub-speciality discipline of Physiatry & Neurology. It is based on our understanding of nervous and muscular system pathophysiology and utilizes the principles of bio-electricity, bio-physics and computer electronics to provide through specialty instrumentation a much more measurable and reproducible sense of the function / dysfunction of these systems; Thus, neuromuscular electrodiagnostic examinations serve as an extension of the clinical exam and are useful in improving the accuracy of diagnosis/prognosis different illnesses presenting with pain, weakness and sensory loss. Such investigations are a necessary addition to imaging studies. Modern computer-based equipment has streamlined and facilitated such studies, thereby benefiting the patient and physician alike. Orthopedic Surgeons, Neurosurgeons, Rheumatologists, Internal Medicine Specialists and many other disciplines of medicine depend on the outcome of Neuroelectrodiagnostic studies to manage their patients. The main procedures used to study nerves and muscles are outlined below:
EMG (electromyographic) Examination: During an EMG, the physician analyzes the electrical activity in the muscles by inserting a fine needle electrode into selected muscles. Needle insertion may cause mild temporary discomfort. The needle is not used for injection and no shocks are given. The physician can determine whether the muscle is working normally by noting the electric activity on a screen and listening over a loudspeaker. The needles are discarded after use.
Nerve Conduction Studies: To perform nerve conduction studies, the physician applies small metal electrodes on the skin and further applies a brief electric stimulus to one or more portions of a nerve. Nerve stimulation will cause a tingling sensation. The physician can then evaluate the electric response of the nerve or muscle to which the nerve is attached and determine if the nerve impulse is (a) conducted normally, (b) at a slow speed, or (c) not transmitted at all, suggesting damage to the nerve or higher control centers.
Evoked Potentials: Electrodiagnosis may also include a number of other tests, such as evoked potentials. These studies use different stimuli, such as auditory clicks, a changing visual pattern such as a checkerboard, or small electric stimuli applied to specific nerves. The recordings are made over the surface of the head, the spine and the extremities to evaluate whether the sensory impulses are conducting normally through the nerves, spinal cord or brain.
Results: The electrodiagnostic physician interprets the results of the studies. Afterward, a report is sent to the referring physician who will then be in the position to coordinate further treatment.
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Current as of
September 7, 2010
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