Neurologic Clinics RSS feed: Current Issue. Neurologic Clinics updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in neurology and is presented under the direction of an experienced guest editor. http://www.neurologic.theclinics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Neurologic Clinics0733-8619302May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.neurologic.theclinics.com/article/PIIS0733861912000072/abstract?rss=yesContributors10.1016/S0733-8619(12)00007-2Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3iiiivhttp://www.neurologic.theclinics.com/article/PIIS0733861912000084/abstract?rss=yesContents10.1016/S0733-8619(12)00008-4Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3vviiihttp://www.neurologic.theclinics.com/article/PIIS0733861912000096/abstract?rss=yesForthcoming Issues10.1016/S0733-8619(12)00009-6Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3ixixhttp://www.neurologic.theclinics.com/article/PIIS0733861911001459/abstract?rss=yesNeuromuscular disorders are commonly encountered in general and specialty neurologic practices. In some instances the diagnosis of a specific neuromuscular condition can be made entirely on clinical grounds, such as a patient who consistently leans on his elbow and develops tingling in his 5th and half of his 4th digits, indicating an ulnar neuropathy. Unfortunately, in many cases the presenting symptoms are nonspecific and could be the result of several possible etiologies, such as a patient with generalized weakness that may be the result of a myopathy, neuromuscular junction disorder, or motor neuron disease. Therefore, in practice, electrodiagnostic testing is an integral and complementary component of the evaluation of patients with suspected neuromuscular conditions.PrefaceDevon I. Rubin10.1016/j.ncl.2011.12.015Neurologic Clinics 30, 2 (2012)2011-12-30Neurologic Clinics2011-12-30302S0733-8619(11)X0006-3xixiihttp://www.neurologic.theclinics.com/article/PIIS0733861911001320/abstract?rss=yesAs a fundamental component of the electrodiagnostic evaluation, nerve conduction studies provide valuable quantitative and qualitative insights into neuromuscular function. Nerve conduction studies are useful in the identification and characterization of several neuromuscular disorders, particularly disorders of peripheral nerve. Abnormalities of nerve conduction studies may anticipate specific pathologic processes, such as demyelination or axonal loss, and may provide precise localization of focal nerve lesions. As with other elements of the electrodiagnostic evaluation, nerve conduction studies must be performed with careful attention to technique and must be interpreted in a clinical context.Nerve Conduction Studies: Basic Concepts and Patterns of AbnormalitiesLyell K. Jones10.1016/j.ncl.2011.12.002Neurologic Clinics 30, 2 (2012)2011-12-30Neurologic Clinics2011-12-30302S0733-8619(11)X0006-3405427http://www.neurologic.theclinics.com/article/PIIS0733861911001393/abstract?rss=yesNeedle electromyography (EMG) records electrical signals generated from muscle fibers and interprets the signals to characterize underlying pathologic changes that are occurring in motor units within muscles. Different types of spontaneously firing waveforms and motor unit potential changes occur with different neuromuscular disorders. The performance of reliable EMG studies depends on the technical skills of the physician in inserting, moving, recording with a needle electrode, and analyzing electric signals recorded from muscle. This article reviews the technique of needle EMG and recognition and interpretation of various EMG waveforms. The author presents several demonstrative videos at www.neurologic.theclinics.com.Needle Electromyography: Basic Concepts and Patterns of AbnormalitiesDevon I. Rubin10.1016/j.ncl.2011.12.009Neurologic Clinics 30, 2 (2012)2012-01-03Neurologic Clinics2012-01-03302S0733-8619(11)X0006-3429456http://www.neurologic.theclinics.com/article/PIIS0733861911001319/abstract?rss=yesCTS is a clinically defined syndrome; however, there is value added by an evidence-based electrodiagnostic approach to (1) efficiently confirm the diagnosis (particularly before invasive interventions), (2) to identify neurogenic mimickers or superimposed processes that may influence the response to treatment, and (3) to stratify the degree of neurogenic injury to help the clinician make management decisions in conjunction with the severity of the clinical symptoms. The literature on the electrodiagnostic diagnosis of CTS is reviewed and an evidence based diagnostic algorithm is proposed. Confounders to CTS electrodiagnostic diagnosis are discussed (crossovers, peripheral neuropathy, and recurrent symptoms after surgical release).The Electrodiagnostic Approach to Carpal Tunnel SyndromeJames C. Watson10.1016/j.ncl.2011.12.001Neurologic Clinics 30, 2 (2012)2012-01-19Neurologic Clinics2012-01-19302S0733-8619(11)X0006-3457478http://www.neurologic.theclinics.com/article/PIIS0733861911001332/abstract?rss=yesUpper extremity mononeuropathies are some of the common disorders seen in neurophysiology laboratories. Electrophysiologic studies rely on accurate localization based on knowledge of applicable anatomy and features of history and physical examination. Careful electrodiagnostic studies provide an accurate diagnosis, help localize the lesion site, exclude alternate diagnoses, reveal unsuspected diagnoses, determine pathophysiology of lesions, and assess severity, timeframe, and prognosis of lesions. This article discusses the electrodiagnostic approach to ulnar neuropathy, proximal median neuropathy, radial neuropathy, musculocutaneous neuropathy, axillary neuropathy, suprascapular neuropathy, and long thoracic neuropathy. Pertinent aspects of the history and physical examination, nerve conduction studies, and electromyography are presented.Electrodiagnostic Evaluation of Ulnar Neuropathy and Other Upper Extremity MononeuropathiesElliot L. Dimberg10.1016/j.ncl.2011.12.003Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3479503http://www.neurologic.theclinics.com/article/PIIS0733861911001344/abstract?rss=yesThis article discusses the anatomy of lower limb mononeuropathies and reviews the general approach to evaluating patients in the electrodiagnostic laboratory with suspected mononeuropathies of the lower limb. Through illustrative cases of patients presenting with a floppy foot, buckling knee, or painful foot, the approaches using nerve conduction studies and needle electromyography are reviewed, and the pattern of findings of peroneal, tibial, sciatic, femoral, and obturator neuropathies is shown.Electrodiagnostic Evaluation of Lower Extremity MononeuropathiesVera Fridman, William S. David10.1016/j.ncl.2011.12.004Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3505528http://www.neurologic.theclinics.com/article/PIIS0733861911001435/abstract?rss=yesElectrodiagnostic studies are an important component of the evaluation of patients with suspected peripheral nerve disorders. The pattern of findings and the features that are seen on the motor and sensory nerve conduction studies and needle electromyography can help to identify the type of neuropathy, define the underlying pathophysiology (axonal or demyelinating), and ultimately help to narrow the list of possible causes. This article reviews the electrodiagnostic approach to and interpretation of findings in patients with peripheral neuropathies.Electrodiagnosis of Peripheral NeuropathyMark A. Ross10.1016/j.ncl.2011.12.013Neurologic Clinics 30, 2 (2012)2012-01-19Neurologic Clinics2012-01-19302S0733-8619(11)X0006-3529549http://www.neurologic.theclinics.com/article/PIIS0733861911001356/abstract?rss=yesThe brachial plexus is one of the largest and most complex structures of the peripheral nervous system and, as such, cannot be studied by a single nerve conduction study (NCS) or muscle sampled by needle electrode examination (NEE). Typically, the screening sensory NCS is used and expanded to identify the region of involvement, the motor NCS is applied to determine the severity of the process, and the NEE is used to further characterize the lesion. Our approach to the electrodiagnostic assessment of the brachial plexus is the focus of this article; 3 electrodiagnostic cases with discussion follow this article.Electrodiagnostic Assessment of the Brachial PlexusMark A. Ferrante10.1016/j.ncl.2011.12.005Neurologic Clinics 30, 2 (2012)2012-01-04Neurologic Clinics2012-01-04302S0733-8619(11)X0006-3551580http://www.neurologic.theclinics.com/article/PIIS0733861911001411/abstract?rss=yesRadiculopathy is a common neurologic disorder. Electrodiagnosis can provide a physiologic assessment of the localization, degree of axon loss, severity, and chronicity of the intraspinal canal lesion, and distinguish it from other neuromuscular disorders. This article reviews electrodiagnostic aspects related to evaluating patients with suspected radiculopathies.Approach to the Patient with Suspected RadiculopathyKerry H. Levin10.1016/j.ncl.2011.12.011Neurologic Clinics 30, 2 (2012)2012-01-19Neurologic Clinics2012-01-19302S0733-8619(11)X0006-3581604http://www.neurologic.theclinics.com/article/PIIS0733861911001368/abstract?rss=yesThe motor neuron diseases are a set of disorders associated with the selective degeneration of motor neurons. Amyotrophic lateral sclerosis (ALS) is the most common and confers the gravest prognosis. Although ALS occurs with known genetic causes in a small minority, other motor neuron disorders have well-defined genetic mutations. Electrodiagnostic testing is important to distinguish these various disorders. Electrodiagnostic testing is also crucial for distinguishing potential mimic syndromes, such as multifocal motor neuropathy and inclusion body myositis. Newer neurophysiology techniques have been developed in the past several years. What role these techniques will play in clinical practice is currently unknown.The Electrophysiology of the Motor Neuron DiseasesEric J. Sorenson10.1016/j.ncl.2011.12.006Neurologic Clinics 30, 2 (2012)2011-12-30Neurologic Clinics2011-12-30302S0733-8619(11)X0006-3605620http://www.neurologic.theclinics.com/article/PIIS0733861911001423/abstract?rss=yesNeuromuscular junction (NMJ) disorders may be demonstrated using repetitive nerve stimulation (RNS) testing and single-fiber electromyography (SFEMG). RNS testing with low frequency stimulation reduces the safety factor of neuromuscular transmission (NMT) and may elicit decrementing compound muscle action potential (CMAP) responses. Exercise or tetanic nerve stimulation may potentiate acetylcholine release in presynaptic NMT disorders with CMAP facilitation. SFEMG is a selective recording technique assessing MFAPs within the same motor unit. Jitter is increased in NMJ disorders, and is the temporal variability between these MFAPs. Impulse blocking reflects failure of NMT. RNS and SFEMG findings in NMJ disorders are reviewed.Evaluation of Neuromuscular Junction Disorders in the Electromyography LaboratoryVern C. Juel10.1016/j.ncl.2011.12.012Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3621639http://www.neurologic.theclinics.com/article/PIIS073386191100137X/abstract?rss=yesElectrodiagnostic testing is a useful component of the approach to a patient with suspected myopathy. It follows the history and is guided by the neurologic examination findings. Uncovering various electrodiagnostic patterns (eg, fibrillation potentials with short-duration motor unit potentials, short-duration motor unit potentials without fibrillation potentials, myotonic discharges, and short-duration motor unit potentials with complex repetitive discharges) can lead to more targeted laboratory testing and a refined differential diagnosis. Electromyography may also be used to detect subclinical myopathy, assess disease activity, and help select a suitable muscle for biopsy.Electrodiagnostic Approach to the Patient with Suspected MyopathyDavid Lacomis10.1016/j.ncl.2011.12.007Neurologic Clinics 30, 2 (2012)2012-01-03Neurologic Clinics2012-01-03302S0733-8619(11)X0006-3641660http://www.neurologic.theclinics.com/article/PIIS0733861911001447/abstract?rss=yesThis article is a general review of cranial nerve conduction studies, including techniques as well as interpretation of data. The needle examination of various cranial innervated muscles is also reviewed. The nerve conduction studies include the blink, masseter (jaw jerk), and masseter inhibitory reflexes, which evaluate the trigeminal (blink and jaw jerk) and facial nerves (blink), as well as trigeminal, facial, and spinal accessory motor stimulation. The needle examination techniques for certain voluntary muscles innervated by cranial nerves V, VII, X, XI, and XII are also described.Electrodiagnostic Approach to Cranial NeuropathiesKathleen D. Kennelly10.1016/j.ncl.2011.12.014Neurologic Clinics 30, 2 (2012)2012-01-19Neurologic Clinics2012-01-19302S0733-8619(11)X0006-3661684http://www.neurologic.theclinics.com/article/PIIS0733861911001381/abstract?rss=yesNerve conduction studies and needle electromyography provide important and complementary information as part of an electrodiagnostic study. Potential technical problems that are encountered during the studies may interfere with accurate and reliable acquisition of information and interpretation of the data. Recognition, identification, and correction of various technical problems are critical to the reliable interpretation of any electrodiagnostic study. Both techniques are safe, but there are potential risks and complications in rare instances. This article reviews technical considerations to assist in accurate interpretation and safe performance of an electrodiagnostic study.Technical Issues and Potential Complications of Nerve Conduction Studies and Needle ElectromyographyDevon I. Rubin10.1016/j.ncl.2011.12.008Neurologic Clinics 30, 2 (2012)2011-12-30Neurologic Clinics2011-12-30302S0733-8619(11)X0006-3685710http://www.neurologic.theclinics.com/article/PIIS0733861912000023/abstract?rss=yesCurrent Procedural Terminology (CPT) codes for electrodiagnostic procedures include codes for nerve conduction studies, nerve tests with preconfigured arrays, reflex tests, electromyography (EMG), and chemodenervation procedures. The codes are updated yearly. For 2012, there are new EMG codes to be used when the patient also receives nerve conduction studies on the same date. Coding for bilateral chemodenervation procedures has also been clarified. The CPT codes for neurologic procedures are not defined to include consultation or other evaluation and management services. When appropriate, codes for these services and skills may be submitted along with the codes for any neurologic procedures.Coding and Reimbursement of Electrodiagnostic StudiesNeil Busis10.1016/j.ncl.2012.01.001Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3711730http://www.neurologic.theclinics.com/article/PIIS073386191100140X/abstract?rss=yesThis article reviews 10 cases that have been evaluated in the electromyography laboratory, which represent a variety of clinical problems that may be referred for electrodiagnostic evaluation. The clinical and electrodiagnostic findings are presented, and practical points related to the approach taken in the evaluation are discussed.A Day in the EMG Laboratory: Case Studies of 10 Patients with Different Clinical ProblemsRachel DiTrapani, Devon I. Rubin10.1016/j.ncl.2011.12.010Neurologic Clinics 30, 2 (2012)2012-01-03Neurologic Clinics2012-01-03302S0733-8619(11)X0006-3731755http://www.neurologic.theclinics.com/article/PIIS0733861912000102/abstract?rss=yesIndex10.1016/S0733-8619(12)00010-2Neurologic Clinics 30, 2 (2012)2012-05-01Neurologic Clinics2012-05-01302S0733-8619(11)X0006-3757779