[Electrodiagnosis of neuromuscular disorders]. 2007

Masahiro Sonoo
Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi ku, Tokyo 173-8606, Japan.

The saying "Electromyography is an extension of the percussion hammer" is a mot juste implying the similarity between neurological examinations and electrodiagnostic tests. First, both look the function and thus are directly related to the symptom of the patient. MRI cannot see the function, and unfortunately, the current wrong practice relying solely on MRI is the source of frequent misdiagnosis. Electrodiagnosis may give an answer to the clinical question that cannot be solved by the neurological examination, and one should freely utilize the electrodiagnostic measures as an adjunct to the neurological symptomatology. Second, both require specialized techniques, which can be obtained only after systematic learning and ample experience. Lastly, one must examine the actual patient, and not the sent sample. Therefore, every referral hospital must have a neurologist and an electrodiagnostic expert. Previously, a clinician might order specific tests and the examiner might perform ordered tests and report EMG results. Ideally, however, an electrodiagnostic expert should re-examine the patient neurologically, especially regarding MMT, plan the whole examination, modify the plan according to the obtained results, and report electrodiagnosis. In Japan, the importance of electrodiagnosis is not fully recognized, one practical reason of which is the too low medical fee for electrodiagnostic tests. That for nerve conduction study (NCS) is one-fiftieth to one-hundredth of that in USA. Electrodiagnostic strategy should start with the patient's symptom. When the patient has weakness, the motor NCS of the weak muscle should be first tested. A normal-size compound muscle action potential of a weak muscle is an important clue to the diagnosis, when central (hysteria or pyramidal weakness) and neurogenic (acute neuro-axonopathy or conduction block) pathology can be differentiated by the recruitment pattern of the needle EMG. Similarly, normal-amplitude sensory nerve action potential is an important clue, and then SEP can localize the lesion.

UI MeSH Term Description Entries
D008297 Male Males
D008511 Medicine The art and science of studying, performing research on, preventing, diagnosing, and treating disease, as well as the maintenance of health. Insurance Medicine,Medical Specialities,Medical Specialties,Medical Specialty,Specialities, Medical,Specialties, Medical,Specialty, Medical,Insurance Medicines,Medical Speciality,Medicine, Insurance,Medicines, Insurance,Speciality, Medical
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009435 Synaptic Transmission The communication from a NEURON to a target (neuron, muscle, or secretory cell) across a SYNAPSE. In chemical synaptic transmission, the presynaptic neuron releases a NEUROTRANSMITTER that diffuses across the synaptic cleft and binds to specific synaptic receptors, activating them. The activated receptors modulate specific ion channels and/or second-messenger systems in the postsynaptic cell. In electrical synaptic transmission, electrical signals are communicated as an ionic current flow across ELECTRICAL SYNAPSES. Neural Transmission,Neurotransmission,Transmission, Neural,Transmission, Synaptic
D009462 Neurology A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system.
D009468 Neuromuscular Diseases A general term encompassing lower MOTOR NEURON DISEASE; PERIPHERAL NERVOUS SYSTEM DISEASES; and certain MUSCULAR DISEASES. Manifestations include MUSCLE WEAKNESS; FASCICULATION; muscle ATROPHY; SPASM; MYOKYMIA; MUSCLE HYPERTONIA, myalgias, and MUSCLE HYPOTONIA. Amyotonia Congenita,Oppenheim Disease,Cramp-Fasciculation Syndrome,Fasciculation-Cramp Syndrome, Benign,Foley-Denny-Brown Syndrome,Oppenheim's Disease,Benign Fasciculation-Cramp Syndrome,Benign Fasciculation-Cramp Syndromes,Cramp Fasciculation Syndrome,Cramp-Fasciculation Syndromes,Fasciculation Cramp Syndrome, Benign,Fasciculation-Cramp Syndromes, Benign,Foley Denny Brown Syndrome,Neuromuscular Disease,Oppenheims Disease,Syndrome, Cramp-Fasciculation,Syndrome, Foley-Denny-Brown,Syndromes, Cramp-Fasciculation
D004568 Electrodiagnosis Diagnosis of disease states by recording the spontaneous electrical activity of tissues or organs or by the response to stimulation of electrically excitable tissue. Electrodiagnoses
D004576 Electromyography Recording of the changes in electric potential of muscle by means of surface or needle electrodes. Electromyogram,Surface Electromyography,Electromyograms,Electromyographies,Electromyographies, Surface,Electromyography, Surface,Surface Electromyographies
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013038 Specialization An occupation limited in scope to a subsection of a broader field. Specialism,Specialists,Specialist

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