Clinical Neurophysiology, Third Edition

Contents......Page 12
Contributors......Page 26
SECTION 1 BASIC NEUROPHYSIOLOGY AND AN INTRODUCTION TO ANALYSIS OF ELECTROPHYSIOLOGIC WAVEFORMS......Page 32
BASIC PRINCIPLES AND DEFINITIONS IN ELECTRICITY......Page 34
CIRCUIT ANALYSIS......Page 36
RESISTIVE–CAPACITIVE AND RESISTIVE–INDUCTIVE CIRCUITS......Page 38
CIRCUITS CONTAINING INDUCTORS AND CAPACITORS......Page 39
FILTER CIRCUITS......Page 43
TRANSISTORS AND AMPLIFIERS......Page 45
ELECTRIC POWER DISTRIBUTION SYSTEMS......Page 50
ELECTRIC SHOCK......Page 51
LEAKAGE CURRENT......Page 54
ELECTRIC SAFETY PRINCIPLES AND IMPLEMENTATION......Page 56
ELECTRIC STIMULATION SAFETY......Page 59
PRINCIPLES......Page 62
SOURCES OF ELECTRICAL POTENTIALS......Page 63
CURRENT SOURCES: MONOPOLES, DIPOLES, AND QUADRUPOLES......Page 67
VOLUME CONDUCTION THEORY: ELECTRIC PROPERTIES IN VOLUME CONDUCTORS......Page 70
APPLICATIONS OF VOLUME CONDUCTION PRINCIPLES......Page 72
DIGITAL COMPUTERS IN CLINICAL NEUROPHYSIOLOGY......Page 82
DIGITIZATION......Page 85
COMMON USES OF DIGITAL PROCESSING......Page 88
AVERAGING......Page 89
DIGITAL FILTERING......Page 91
TIME AND FREQUENCY DOMAIN ANALYSIS......Page 92
CELL MEMBRANE......Page 98
RESTING POTENTIAL......Page 105
LOCAL POTENTIALS......Page 107
ACTION POTENTIALS......Page 111
SYNAPTIC TRANSMISSION......Page 117
CLINICAL CORRELATIONS......Page 122
STRUCTURAL GENERATORS......Page 126
CONTINUOUS WAVEFORMS......Page 132
EVENT RECORDING......Page 135
PHYSIOLOGIC ALTERATION OF WAVEFORMS......Page 137
ARTIFACTUAL WAVEFORMS......Page 140
SECTION 2 ELECTROPHYSIOLOGIC ASSESSMENT OF NEURAL FUNCTION......Page 144
Part A: Assessment of Cortical Function......Page 146
DISPLAY OF EEG ACTIVITY......Page 148
ACTIVATION PROCEDURES......Page 149
ARTIFACTS......Page 152
NORMAL EEG ACTIVITY OF ADULTS......Page 153
BENIGN VARIANTS......Page 159
INTRODUCTION AND OVERVIEW OF EPILEPTIFORM ACTIVITY......Page 166
SPECIFIC FOCAL INTERICTAL DISCHARGES......Page 167
GENERALIZED EPILEPTIFORM PATTERNS......Page 170
ICTAL DISCHARGES......Page 174
EPILEPTIFORM ACTIVITY WITH A POTENTIAL SEIZURE ASSOCIATION......Page 177
INTRODUCTION......Page 180
TYPES OF EEG ABNORMALITIES......Page 181
FOCAL INTRACRANIAL PROCESSES CAUSING EEG ABNORMALITIES......Page 183
ELECTROENCEPHALOGRAPHIC MANIFESTATIONS OF DIFFUSE DISORDERS......Page 188
EVALUATION FOR SUSPECTED BRAIN DEATH......Page 193
INTRODUCTION......Page 196
NEONATAL EEG PATTERNS......Page 197
DEVELOPMENTAL CHANGES DURING INFANCY, CHILDHOOD, AND ADOLESCENCE......Page 202
ABNORMALITIES......Page 204
INDICATIONS......Page 216
TECHNOLOGY......Page 217
CLINICAL APPLICATIONS......Page 218
INTRODUCTION......Page 222
EQUIPMENT......Page 223
CLINICAL APPLICATION......Page 224
QUANTITATIVE METHODS OF ELECTROENCEPHALOGRAPHIC ANALYSIS......Page 232
MAGNETOENCEPHALOGRAPHY......Page 240
BACKGROUND......Page 244
PRESURGICAL SELECTION AND EVALUATION......Page 245
PREOPERATIVE VIDEO-EEG MONITORING......Page 247
PRESURGICAL EVALUATION WITH CONTINUOUS OR CHRONIC INTRACRANIAL MONITORING......Page 248
INTRAOPERATIVE ELECTROCORTICOGRAPHY......Page 252
MOVEMENT-RELATED CORTICAL POTENTIALS......Page 258
EVENT-RELATED POTENTIALS......Page 261
Part B: Sensory Pathways......Page 266
INTRODUCTION......Page 268
PATHOPHYSIOLOGY OF SNAPs......Page 269
METHODS OF STUDY OF SNAPs......Page 272
MEASUREMENTS......Page 276
TECHNICAL FACTORS......Page 277
PLANNING THE STUDY AND FINDINGS IN DISEASES......Page 280
INTRODUCTION......Page 286
METHODS......Page 287
RECORDING......Page 289
LOCALIZATION......Page 297
CLINICAL APPLICATIONS......Page 298
INTRODUCTION......Page 310
GENERATORS OF THE BRAIN STEM AUDITORY EVOKED POTENTIALS......Page 312
BRAIN STEM AUDITORY EVOKED POTENTIALS: METHODS......Page 313
FACTORS AFFECTING THE BAEP RESPONSE......Page 315
INTERPRETATION OF BAEPs......Page 316
CLINICAL APPLICATIONS......Page 317
INTRODUCTION......Page 324
AUDIOGRAM......Page 325
ACOUSTIC REFLEX......Page 327
EVOKED OTOACOUSTIC EMISSIONS......Page 330
APPLICATIONS......Page 332
INTRODUCTION......Page 334
INTERPRETATION......Page 335
APPLICATIONS......Page 337
INTRODUCTION......Page 340
VISUAL EVOKED POTENTIALS: METHODS......Page 341
FACTORS AFFECTING THE VEP RESPONSE......Page 343
INTERPRETATION OF VEPs......Page 346
LOCALIZATION OF VISUAL SYSTEM LESIONS......Page 347
Part C: Motor Pathways......Page 354
INTRODUCTION......Page 356
GENERAL CLINICAL APPLICATIONS......Page 357
RECORDING CMAPs......Page 358
STIMULATION......Page 361
CMAP MEASUREMENTS......Page 363
F WAVES......Page 367
AXON REFLEXES (A WAVES)......Page 371
PHYSIOLOGIC VARIABLES AFFECTING THE CMAP......Page 372
CMAP CHANGES IN DISEASE......Page 373
FINDINGS IN PERIPHERAL NERVE DISORDERS......Page 375
INTRODUCTION......Page 398
ANATOMY AND PHYSIOLOGY OF THE NEUROMUSCULAR JUNCTION......Page 399
TECHNIQUE......Page 401
CRITERIA OF ABNORMALITY......Page 406
RAPID RATES OF STIMULATION......Page 407
SELECTION OF NERVE–MUSCLE COMBINATIONS......Page 408
CLINICAL CORRELATIONS......Page 409
INTRODUCTION......Page 414
TECHNIQUE......Page 415
MEP PHARMACOLOGY......Page 421
APPLICATIONS......Page 422
CONTRAINDICATIONS AND RISKS......Page 424
Part D: Assessing the Motor Unit......Page 430
26. ASSESSING THE MOTOR UNIT WITH NEEDLE ELECTROMYOGRAPHY......Page 432
KNOWLEDGE BASE OF NEEDLE EMG......Page 433
CONDUCTING THE NEEDLE EXAMINATION......Page 434
POTENTIAL COMPLICATIONS DURING NEEDLE EXAMINATION......Page 438
NEEDLE ELECTRODE CHARACTERISTICS......Page 441
SKILLS OF EMG WAVEFORM RECOGNITION......Page 442
ORIGIN OF EMG POTENTIALS......Page 444
NORMAL EMG ACTIVITY......Page 446
ABNORMAL SPONTANEOUS ELECTRIC ACTIVITY......Page 453
ABNORMAL ELECTRICAL ACTIVITY—VOLUNTARY MUPs......Page 466
PATTERNS OF ABNORMALITIES......Page 474
INTRODUCTION......Page 480
CHARACTERISTICS OF THE MOTOR UNIT POTENTIAL......Page 482
CHARACTERISTICS OF THE RECORDING EQUIPMENT......Page 483
PROPERTIES OF MUPs EVALUATED USING STANDARD ELECTRODES......Page 485
PROPERTIES OF MUPs MEASURABLE ONLY WITH SPECIAL ELECTRODES......Page 489
QUANTITATIVE ANALYSIS OF SINGLE MUPs......Page 491
PROPERTIES OF INTERFERENCE PATTERN AND METHODS OF INTERFERENCE PATTERN ANALYSIS......Page 496
TURNS AND AMPLITUDE ANALYSIS OF THE INTERFERENCE PATTERN......Page 498
POWER-SPECTRUM ANALYSIS......Page 500
AUTOMATED METHODS OF ANALYSIS OF SPONTANEOUS ACTIVITY......Page 501
INTRODUCTION......Page 504
TECHNIQUE......Page 506
PITFALLS OF SFEMG......Page 512
CLINICAL APPLICATIONS OF SFEMG......Page 515
INTRODUCTION......Page 522
MUNE BY STANDARD EMG......Page 524
MUNE BY STANDARD MOTOR NCS......Page 525
QUANTITATIVE MUNE......Page 526
CLINICAL APPLICATIONS......Page 539
Part E: Reflexes and Central Motor Control......Page 546
PHYSIOLOGIC BASIS......Page 548
TECHNIQUE......Page 550
CLINICAL APPLICATIONS......Page 553
INTRODUCTION......Page 558
BLINK REFLEX......Page 559
LATERAL SPREAD OF THE FACIAL NERVE RESPONSE: ASSESSMENT OF FACIAL SYNKINESIS AND HEMIFACIAL SPASM......Page 564
JAW JERK (MASSETER REFLEX)......Page 566
MASSETER INHIBITORY REFLEX......Page 567
TRIGEMINAL CONTACT HEAT EVOKED POTENTIAL STIMULATOR STUDIES......Page 569
LONG LATENCY REFLEXES......Page 572
THE SILENT PERIOD......Page 575
INTRODUCTION......Page 580
TECHNIQUES......Page 581
EEG......Page 582
TREMOR......Page 583
MYOCLONUS......Page 588
PERIODIC LIMB MOVEMENTS OF SLEEP......Page 597
DYSTONIA......Page 598
VOLUNTARY MOVEMENT ABNORMALITIES......Page 600
INTRODUCTION......Page 604
LABORATORY EXAMINATION: VOR-BASED MEASURES......Page 611
LABORATORY EXAMINATION: VSR-BASED MEASURES......Page 628
CLINICAL APPLICATIONS OF VESTIBULAR TESTING: ASSESSING SENSORINEURAL SYNDROMES OF THE LABYRINTH......Page 636
VESTIBULAR REHABILITATION......Page 639
Part F: Autonomic Function......Page 644
SYMPTOMS AND DISEASES......Page 646
GENERAL ORGANIZATION OF THE AUTONOMIC SYSTEM......Page 648
SYMPATHETIC FUNCTION......Page 650
SYMPATHETIC INNERVATION OF THE SKIN......Page 651
MUSCLE SYMPATHETIC ACTIVITY......Page 652
CARDIOVASCULAR REFLEXES......Page 653
MAINTENANCE OF POSTURAL NORMOTENSION......Page 655
LABORATORY EVALUATION OF AUTONOMIC FUNCTION......Page 658
QUANTITATIVE SUDOMOTOR AXON REFLEX TEST......Page 659
IMPRINT METHODS OF SWEAT MEASUREMENT......Page 663
SKIN VASOMOTOR REFLEXES......Page 666
INTRODUCTION......Page 674
ROLE OF THERMOREGULATORY SWEAT TESTING: CLINICAL SYNDROMES AND PROBLEMS EVALUATED......Page 675
METHOD......Page 679
THERMOREGULATORY SWEAT DISTRIBUTION......Page 682
REPORTING RESULTS......Page 685
DIFFICULTIES AND PITFALLS IN INTERPRETATION......Page 686
INTRODUCTION......Page 690
HEART RATE RESPONSE TO DEEP BREATHING......Page 691
THE VALSALVA MANEUVER......Page 694
POWER SPECTRUM ANALYSIS......Page 699
HEART RATE RESPONSE TO STANDING......Page 700
OTHER TESTS OF CARDIOVAGAL FUNCTION......Page 701
INTRODUCTION......Page 706
QUANTITATIVE SENSORY TEST......Page 707
AUTONOMIC TESTS......Page 710
MICRONEUROGRAPHY......Page 712
LASER EVOKED POTENTIALS......Page 713
CONTACT HEAT EVOKED POTENTIALS......Page 717
Part G: Sleep and Consciousness......Page 724
INTRODUCTION......Page 726
TECHNIQUES USED IN STUDYING SLEEP......Page 727
STAGING OF SLEEP......Page 735
ASSESSING RESPIRATION DURING SLEEP......Page 741
ASSESSING MOVEMENTS IN SLEEP......Page 744
PERFORMANCE OF A SLEEP STUDY......Page 747
ASSESSING SLEEP DISORDERS......Page 748
Part H: Intraoperative Monitoring......Page 754
TECHNICAL FACTORS IN INTRAOPERATIVE EEG MONITORING......Page 756
EFFECTS OF ANESTHESIA ON ELECTROENCEPHALOGRAPHY SYMMETRICAL EEG PATTERNS DURING ANESTHESIA......Page 760
PREOPERATIVE FOCAL ABNORMALITIES SEEN WITH ANESTHESIA......Page 761
EEG CHANGES DURING CAROTID ENDARTERECTOMY......Page 762
OTHER MONITORING TECHNIQUES DURING CAROTID ENDARTERECTOMY......Page 764
EEG MONITORING FOR EPILEPSY SURGERY......Page 765
INTRODUCTION......Page 768
METHODS......Page 769
APPLICATIONS......Page 772
INTRODUCTION......Page 780
GENERAL PRINCIPLES OF INTRAOPERATIVE MONITORING......Page 781
EQUIPMENT AND ELECTRICAL SAFETY......Page 782
MONITORING METHODS—SOMATOSENSORY EVOKED POTENTIALS......Page 783
MOTOR EVOKED POTENTIALS......Page 789
ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES......Page 794
TYPES OF SPINAL SURGERIES......Page 797
INTRODUCTION......Page 806
METHODS......Page 807
APPLICATIONS......Page 809
SECTION 3 APPLICATIONS OF CLINICAL NEUROPHYSIOLOGY: ASSESSING SYMPTOM COMPLEXES AND DISEASE ENTITIES......Page 816
ASSESSMENT OF MOTOR SYMPTOMS OF CENTRAL ORIGIN......Page 820
ASSESSING IMPAIRMENT OF VISCERAL FUNCTION AND SLEEP......Page 821
ASSESSING CLINICAL DISORDERS WITH EEG......Page 822
47. APPLICATION OF CLINICAL NEUROPHYSIOLOGY: ASSESSING PERIPHERAL NEUROMUSCULAR SYMPTOM COMPLEXES......Page 830
CLINICAL NEUROPHYSIOLOGY IN THE ASSESSMENT OF PERIPHERAL NERVOUS SYSTEM DISORDERS......Page 831
RADICULOPATHIES......Page 835
COMMON FOCAL MONONEUROPATHIES......Page 837
PERIPHERAL NEUROPATHY......Page 839
BRACHIAL PLEXOPATHY......Page 846
GENERALIZED WEAKNESS......Page 851
MYOPATHY......Page 852
NMJ DISORDERS......Page 856
POLYRADICULOPATHY......Page 858
MOTOR NEURON DISEASE......Page 859
ANOMALOUS INNERVATION......Page 860
UNEXPECTED FINDINGS ON NERVE CONDUCTION STUDIES: CAUSE AND ACTION......Page 864
A......Page 868
B......Page 870
C......Page 871
D......Page 873
E......Page 875
F......Page 877
G......Page 878
I......Page 879
L......Page 881
M......Page 882
N......Page 885
P......Page 887
R......Page 889
S......Page 891
T......Page 894
W......Page 896
A......Page 898
B......Page 899
C......Page 900
D......Page 901
E......Page 902
F......Page 903
I......Page 904
L......Page 905
M......Page 906
N......Page 907
P......Page 909
R......Page 910
S......Page 911
T......Page 913
V......Page 914
X......Page 915