Neurophysiology during peripheral nerve surgery.

Electrophysiological monitoring of the peripheral nervous system during a variety of surgeries provides useful information that supplements and complements preoperative assessment. Monitoring improves localization and understanding of the underlying pathophysiology of peripheral nerve lesions leading to more rational treatment decisions and improved outcomes. Monitoring is accomplished by adaptation of routine electrodiagnostic techniques (i.

Impact of long-term epidural electrical stimulation enabled task-specific training on secondary conditions of chronic paraplegia in two humans.

Spinal cord injury (SCI) often results in chronic secondary health conditions related to autonomic and metabolic dysfunction. Epidural electrical stimulation (EES) combined with task-specific training has been shown to enable motor function in individuals with chronic paralysis. The reported effects of EES on secondary health conditions, such as bladder function and body composition, are limited.

Correction to: Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary.

The article Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary, written by Stanley A. Skinner, Elif Ilgaz Aydinlar, Lawrence F. Borges, Bob S.

Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis.

Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described.

Publisher Correction: Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia.

In the version of this article originally published, Dimitry G. Sayenko's affiliations were not correct. The following affiliation for this author was missing: Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA.

Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia.

We report a case of chronic traumatic paraplegia in which epidural electrical stimulation (EES) of the lumbosacral spinal cord enabled (1) volitional control of task-specific muscle activity, (2) volitional control of rhythmic muscle activity to produce steplike movements while side-lying, (3) independent standing, and (4) while in a vertical position with body weight partially supported, voluntary control of steplike movements and rhythmic muscle activity. This is the first time that the application of EES enabled all of these tasks in the same patient within the first 2 weeks (8 stimulation sessions total) of EES therapy.

Motor evoked potential monitoring during cryoablation of musculoskeletal tumors.

Purpose: To describe the use of intraprocedural motor evoked potential (MEP) monitoring to minimize risk of neural injury during percutaneous cryoablation of perineural musculoskeletal tumors.

Materials And Methods: A single-institution retrospective review of cryoablation procedures performed to treat perineural musculoskeletal tumors with the use of MEP monitoring between May 2011 and March 2013 yielded 59 procedures to treat 64 tumors in 52 patients (26 male). Median age was 61 years (range, 4-82 y).

Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy.

Objectives: To determine the sensitivity and specificity of B-mode ultrasound in the diagnosis of neuromuscular diaphragmatic dysfunction, including phrenic neuropathy.

Methods: A prospective study of patients with dyspnea referred to the EMG laboratory over a 2-year time frame for evaluation of neuromuscular respiratory failure who were recruited consecutively and examined with ultrasound for possible diaphragm dysfunction. Sonographic outcome measures were absolute thickness of the diaphragm and degree of increased thickness with maximal inspiration.

B-mode ultrasound assessment of diaphragm structure and function in patients with COPD.

Background: Electromyographic evaluation of diaphragmatic neuromuscular disease in patients with COPD is technically difficult and potentially high risk. Defining standard values for diaphragm thickness and thickening ratio using B-mode ultrasound may provide a simpler, safer means of evaluating these patients.

Methods: Fifty patients with a diagnosis of COPD and FEV₁ < 70% underwent B-mode ultrasound.

Evaluation, treatment, and outcomes of suprascapular neuropathy: a 5-year review.

Objective: To report our diagnostic and treatment experiences, and patient outcomes, in patients with suprascapular neuropathy (SSN).

Design: Retrospective cohort study.

Setting: A tertiary medical center.

Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound.

Study Design: Clinical measurement, cross-sectional.

Objectives: To establish a set of normal values for diaphragm thickening with tidal breathing in healthy subjects.

Background: Normal values for diaphragm contractility, as imaged sonographically, have not been described, despite the known role of the diaphragm in contributing to spinal stability.

Diaphragm depth in normal subjects.

Introduction: Needle electromyography (EMG) of the diaphragm carries the potential risk of pneumothorax. Knowing the approximate depth of the diaphragm should increase the test's safety and accuracy.

Methods: Distances from the skin to the diaphragm and from the outer surface of the rib to the diaphragm were measured using B mode ultrasound in 150 normal subjects.

Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects.

Introduction: Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure.

Methods: We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history.

Results: The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.

Management of spasticity from spinal cord dysfunction.

Spasticity is a common component of those with spinal cord dysfunction. Spasticity can lead not only to pain and potential secondary complications such as contracture and pressure sores but also to significant functional impairment. The clinician must identify specific goals of spasticity treatment and assess the potential benefit of spasticity, particularly as it pertains to transfers and ambulation.

Hematoma risk after needle electromyography.

Introduction: Although needle electromyography (EMG) appears to be a relatively safe procedure based primarily on clinical experience, no evidence-based guidelines exist for EMG procedures in patients taking anticoagulant or antiplatelet medications. We sought to determine whether there is an increased risk of hematoma formation after EMG of potentially high-risk muscles in patients taking anticoagulant or antiplatelet agents.

Methods: After undergoing routine EMG, if any of seven predetermined high-risk muscles were tested, study subjects then underwent ultrasound to evaluate for hematoma formation.

Accuracy of diagnoses delivered by an automated hand-held nerve conduction device in comparison to standard electrophysiological testing in patients with unilateral leg symptoms.

Introduction: Automated hand-held nerve conduction study (NCS) devices are being marketed for use in the diagnosis of lumbosacral radiculopathy (LSR). In this study we compared the specificity and sensitivity of a hand-held NCS device for the detection of LSR with standard electrodiagnostic study (EDX).

Methods: Fifty patients referred to a tertiary referral electromyography (EMG) laboratory for testing of predominantly unilateral leg symptoms (weakness, sensory complaints, and/or pain) were included in the investigation.

Peripheral nerve stimulation and monitoring during operative procedures.

Monitoring of peripheral nerve function is important during the surgical treatment of peripheral nerve and plexus lesions, allowing for rapid assessment of the integrity of the roots, plexus, and nerves. The results of this monitoring assist the surgeon in the overall approach to treatment of these lesions. There are, however, many technical challenges to providing this neurophysiological information in an accurate and rapid fashion.

Neuromuscular rehabilitation and electrodiagnosis. 4. Pediatric issues.

Unlabelled: This self-directed learning module highlights the physician's role in the diagnosis and treatment of neuromuscular disorders in pediatric populations. 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 discusses both clinical and electrodiagnostic features of common neuromuscular disorders in pediatric populations.

Neuromuscular rehabilitation and electrodiagnosis. 3. Diseases of muscles and neuromuscular junction.

Unlabelled: This self-directed learning module highlights formation of a differential diagnosis as well as electrodiagnostic evaluation for those patients who present with the common complaint of weakness. 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 specifically focuses on the common symptoms and typical clinical findings that allow the clinician to narrow the differential diagnosis.

Neuromuscular rehabilitation and electrodiagnosis. 2. Peripheral neuropathy.

Unlabelled: This self-directed learning module highlights peripheral neuropathies. 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 specifically focuses on diagnostic criteria and classifications of peripheral neuropathy, including diabetic, alcoholic, carcinomatous, human immunodeficiency virus-associated, and critical illness polyneuropathies.

Neuromuscular rehabilitation and electrodiagnosis. 1. Mononeuropathy.

Unlabelled: This self-directed learning module highlights mononeuropathies. 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 specifically focuses on diagnostic criteria and classifications of mononeuropathies, including carpal tunnel, brachial neuritis, and lumbosacral plexopathy.

Transgenic overexpression of human DMPK accumulates into hypertrophic cardiomyopathy, myotonic myopathy and hypotension traits of myotonic dystrophy.

Abnormal expression of human myotonic dystrophy protein kinase (hDMPK) gene products has been implicated in myotonic dystrophy type 1 (DM1), yet the impact of distress accumulation produced by persistent overexpression of this poorly understood member of the Rho kinase-related protein kinase gene-family remains unknown. Here, in the aged transgenic murine line carrying approximately 25 extra copies of a complete hDMPK gene with all exons and an intact promoter region (Tg26-hDMPK), overexpression of mRNA and protein transgene products in cardiac, skeletal and smooth muscles resulted in deficient exercise endurance, an integrative index of muscle systems underperformance. In contrast to age-matched (11-15 months) wild-type controls, hearts from Tg26-hDMPK developed cardiomyopathic remodeling with myocardial hypertrophy, myocyte disarray and interstitial fibrosis.