9780195385113

Table of Contents


	Contributors	xxv
SECTION 1	BASIC NEUROPHYSIOLOGY AND AN INTRODUCTION TO ANALYSIS OF ELECTROPHYSIOLOGIC WAVEFORMS
1	Electricity and Electronics for Clinical Neurophysiology Terrence D. Lagerlund	5
	Basic Principles and Definitions in Electricity	5
	Circuit Analysis	7
	Resistive–Capacitive and Resistive–Inductive Circuits	9
	Circuits Containing Inductors and Capacitors	10
	Filter Circuits	14
	Transistors and Amplifiers	16
2	Electric Safety in the Laboratory and Hospital Terrence D. Lagerlund	21
	Introduction	21
	Electric Power Distribution Systems	21
	Electric Shock	22
	Leakage Current	25
	Electric Safety Principles and Implementation	27
	Electric Stimulation Safety	30
3	Volume Conduction Terrence D. Lagerlund, Devon I. Rubin, and Jasper R. Daube	33
	Principles	33
	Sources of Electrical Potentials	34
	Current Sources: Monopoles, Dipoles, and Quadrupoles	38
	Volume Conduction Theory: Electric Properties in Volume Conductors	41
	Applications of Volume Conduction Principles	43
4	Digital Signal Processing Terrence D. Lagerlund	53
	Digital Computers in Clinical Neurophysiology	53
	Digitization	56
	Common Uses of Digital Processing	59
	Averaging	60
	Digital Filtering	62
	Time and Frequency Domain Analysis	63
5	Basics of Neurophysiology Jasper R. Daube and Squire M. Stead	69
	Introduction	69
	Cell Membrane	69
	Resting Potential	76
	Local Potentials	78
	Action Potentials	82
	Synaptic Transmission	88
	Clinical Correlations	93
6	Electrophysiologic Generators in Clinical Neurophysiology Terrence D. Lagerlund	97
	Structural Generators	97
7	Waveforms and Artifacts Jasper R. Daube	103
	Introduction	103
	Continuous Waveforms	103
	Event Recording	106
	Combinations of Continuous Waveforms and Events	108
	Waveform Alterations	108
	Physiologic Alteration of Waveforms	108
	Artifactual Waveforms	111
SECTION 2	ELECTROPHYSIOLOGIC ASSESSMENT OF NEURAL FUNCTION
PART A	ASSESSMENT OF CORTICAL FUNCTION
8	Electroencephalography: Adult, Normal, and Benign Variants Barbara F. Westmoreland	119
	Introduction	119
	Recording the Electroencephalogram	119
	Display of EEG Activity	119
	Activation Procedures	120
	Artifacts	123
	Normal EEG Activity of Adults	124
	Benign Variants	130
9	Epileptiform Activity Joseph F. Drazkowski	137
	Introduction and Overview of Epileptiform Activity	137
	Specific Focal Interictal Discharges	138
	Generalized Epileptiform Patterns	141
	Ictal Discharges	145
	Epileptiform Activity with a Potential Seizure Association	148
10	Adult EEG: Abnormal Nonepileptiform Activity Barbara F. Westmoreland	151
	Introduction	151
	Types of EEG Abnormalities	152
	Focal Intracranial Processes Causing EEG Abnormalities	154
	Electroencephalographic Manifestations of Diffuse Disorders	159
	Evaluation for Suspected Brain Death	164
11	Electroencephalography: Electroencephalograms of Infants and Children Barbara F. Westmoreland	167
	Introduction	167
	Neonatal EEG Patterns	168
	Developmental Changes during Infancy, Childhood, and Adolescence	173
	Benign Variants in Children	175
	Abnormalities	175
12	Ambulatory Electroencephalography Jeffrey R. Buchhalter	187
	Introduction	187
	Indications	187
	Technology	188
	Clinical Applications	189
13	Prolonged Video Electroencephalography Cheolsu Shin	193
	Introduction	193
	Equipment	194
	Clinical Application	195
14	Electroencephalographic Special Studies Gregory A. Worrell and Terrence D. Lagerlund	203
	Introduction	203
	Quantitative Methods of Electroencephalographic Analysis	203
	Magnetoencephalocraphy	211
15	Electroencephalography in the Surgical Evaluation of Epilepsy Joseph F. Drazkowski	215
	Background	215
	Presurgical Selection and Evaluation	216
	Routine EEG in the Surgical Evaluation of Patients with Seizures	218
	Preoperative Video-EEG Monitoring	218
	Presurgical Evaluation with Continuous or Chronic Intracranial Monitoring	219
	Intraoperative Electrocorticography	223
16	Movement-Related Cortical Potentials and Event-Related Potentials Virgilio Gerald H. Evidente and John N. Caviness	229
	Movement-Related Cortical Potentials	229
	Event-Related Potentials	232
PART B	SENSORY PATHWAYS
17	Sensory Nerve Action Potentials Eric J. Sorenson	239
	Introduction	239
	Pathophysiology of SNAPs	240
	Methods of Study of SNAPs	243
	Measurements	247
	Technical Factors	248
	Planning the Study and Findings in Diseases	251
18	Somatosensory Evoked Potentials Jonathan L. Carter and J. Clarke Stevens	257
	Introduction	257
	Generators and Origin of SEPs	258
	Methods	258
	Recording	260
	Localization	268
	Clinical Applications	269
19	Brain Stem Auditory Evoked Potentials in Central Disorders Jonathan L. Carter	281
	Introduction	281
	Auditory Anatomy and Physiology	283
	Generators of the Brain Stem Auditory Evoked Potentials	283
	Brain Stem Auditory Evoked Potentials: Methods	284
	Factors Affecting the Baep Response	286
	Interpretation of BAEPs	287
	Clinical Applications	288
20	Audiogram, Acoustic Reflexes, and Evoked Otoacoustic Emissions Christopher D. Bauch and Wayne O. Olsen	295
	Introduction	295
	Audiocram	296
	Acoustic Reflex	298
	Evoked Otoacoustic Emissions	301
	Applications	303
21	Brain Stem Auditory Evoked Potentials in Peripheral Acoustic Disorders Christopher D. Bauch	305
	Introduction	305
	Stimuli	306
	Electrodes	306
	Interpretation	306
	Applications	308
22	Visual Evoked Potentials Jonathan L. Carter	311
	Introduction	311
	Visual System Anatomy and Physiology	312
	Visual Evoked Potentials: Methods	312
	Factors Affecting the Vep Response	314
	Interpretation of VEPs	317
	Localization of Visual System Lesions	318
PART C	MOTOR PATHWAYS
23	Compound Muscle Action Potentials James C. Watson and Jasper R. Daube	327
	Introduction	327
	General Clinical Applications	328
	Recording CMAPs	329
	Stimulation	332
	CMAP Measurements	334
	F Waves	338
	Axon Reflexes (A Waves)	342
	Physiologic Variables Affecting the CMAP	343
	CMAP Changes in Disease	344
	Findings in Peripheral Nerve Disorders	346
24	Assessing the Neuromuscular Junction with Repetitive Stimulation Studies Andrea J. Boon	369
	Introduction	369
	Anatomy and Physiology of the Neuromuscular Junction	370
	Technique	372
	Criteria of Abnormality	377
	Rapid Rates of Stimulation	378
	Selection of Nerve–Muscle Combinations	379
	Clinical Correlations	380
25	Motor Evoked Potentials Jeffrey A. Strommen	385
	Introduction	385
	Technique	386
	MEP Pharmacology	392
	Applications	393
	Contraindications and Risks	395
PART D	ASSESSING THE MOTOR UNIT
26	Assessing the Motor Unit with Needle Electromyography Devon I. Rubin	403
	Introduction	404
	Knowledge Base of Needle EMG	404
	Technique of Needle Examination	405
	Conducting the Need Le Examination	405
	Potential Complications during Needle Examination	409
	EMG Signal Analysis	412
	Needle Electrode Characteristics	412
	Skills of EMG Waveform Recognition	413
	Origin of EMG Potentials	415
	Normal EMG Activity	417
	Abnormal Spontaneous Electric Activity	424
	Abnormal Electrical Activity—Voluntary MUPs	437
	Abnormal Electrical Activity—Disorders of Central Control	445
	Patterns of Abnormalities	445
27	Quantitative Electromyography Benn E. Smith	451
	Introduction	451
	Characteristics of the Motor Unit Potential	453
	Characteristics of the Recording Equipment	454
	Properties of MUPs Evaluated Using Standard Electrodes	456
	Properties of MUPs Measurable Only with Special Electrodes	460
	Quantitative Analysis of Single MUPs	462
	Properties of Interference Pattern and Methods of Interference Pattern Analysis	467
	Turns and Amplitude Analysis of the Interference Pattern	469
	Power-Spectrum Analysis	471
	Automated Methods of Analysis of Spontaneous Activity	472
28	Single Fiber Electromyography C. Michel Harper, Jr.	475
	Introduction	475
	Technique	477
	Pitfalls of SFEMG	483
	Clinical Applications of SFEMG	486
29	Quantitative Motor Unit Number Estimates Jasper R. Daube	493
	Introduction	493
	Mune by Standard EMG	495
	Mune by Standard Motor NCS	496
	Quantitative Mune	497
	Clinical Applications	510
PART E	REFLEXES AND CENTRAL MOTOR CONTROL
30	H Reflexes Ruple S. Laughlin	519
	Introduction	519
	Physiologic Basis	519
	Technique	521
	Pediatric H Reflexes	524
	Clinical Applications	524
31	Cranial Reflexes and Related Techniques Benn E. Smith	529
	Introduction	529
	Blink Reflex	530
	Lateral Sphead of the Facial Nerve Response: Assessment of Facial Synkinesis and Hemifacial Spasm	535
	Jaw Jerk (Masseter Reflex)	537
	Masseter Inhibitory Reflex	538
	Great Auricular Sensory Nerve Conduction Studies	540
	Trigeminal Contact Heat Evoked Potential Stimulator Studies	540
32	Long Latency Reflexes and the Silent Period John N. Caviness	543
	Introduction	543
	Long Latency Reflexes	543
	The Silent Period	546
33	Movement Disorders John N. Caviness	551
	Introduction	551
	Techniques	552
	EEG	553
	Surface EMG: Normal Patterns	554
	Tremor	554
	Myoclonus	559
	Psychogenic Jerks	568
	Startle Disorders	568
	Periodic Limb Movements of Sleep	568
	Dystonia	569
	Tics, Chorea, and Athetosis	571
	Voluntary Movement Abnormalities	571
34	Vertigo and Balance David A. Zapala and Robert H. Brey	575
	Introduction	575
	Laboratory Examination: VOR-Based Measures	582
	Laboratory Examination: VSR-Based Measures	599
	Clinical Applications of Vestibular Testing: Assessing Sensorineural Syndromes of the Labyrinth	607
	Vestibular Rehabilitation	610
PART F	AUTONOMIC FUNCTION
35	Autonomic Physiology William P. Cheshire, Jr.	617
	Introduction	617
	Symptoms and Diseases	617
	General Organization of the Autonomic System	619
	Sympathetic Function	621
	Sympathetic Innervation of the Skin	622
	Muscle Sympathetic Activity	623
	Autonomic Control of Heart Hate	624
	Cardiovascular Reflexes	624
	Maintenance of Postural Normotension	626
36	Quantitative Sudomotor Axon Reflex and Related Tests Phillip A. Low	629
	Introduction	629
	Laboratory Evaluation of Autonomic Function	629
	Quantitative Sudomotor Axon Reflex Test	630
	Imprint Methods of Sweat Measurement	634
37	Evaluation of Adrenergic Function Phillip A. Low	637
	Introduction	637
	Skin Vasomotor Reflexes	637
38	Thermoregulatory Sweat Test Robert D. Fealey	645
	Introduction	645
	Role of Thermoregulatory Sweat Testing: Clinical Syndromes and Problems Evaluated	646
	Method	650
	Thermoregulatory Sweat Distribution	653
	Reporting Results	656
	Difficulties and Pitfalls in Interpretation	657
39	Cardiovagal Reflexes William P. Cheshire, Jr.	661
	Introduction	661
	Heart Rate Response to Deep Breathing	662
	The Valsalva Maneuver	665
	Cardiovagal Scoring	670
	Power Spectrum Analysis	670
	Heart Rate Response to Standing	671
	Other Tests of Cardiovagal Function	672
40	Electrophysiology of Pain Rose M. Dotson and Paola Sandroni	677
	Introduction	677
	Quantitative Sensory Test	678
	Autonomic Tests	681
	Microneurography	683
	Laser Evoked Potentials	684
	Contact Heat Evoked Potentials	688
PART G	SLEEP AND CONSCIOUSNESS
41	Assessment of Sleep and Sleep Disorders Michael H. Silber, Cameron D. Harris, and Peter J. Hauri	697
	Introduction	697
	Techniques Used Tn Studying Sleep	698
	Staging of Sleep	706
	Assessing Respiration during Sleep	712
	Assessing Movements in Sleep	715
	Assessing Other Physiologic Variables	718
	Performance of a Sleep Study	718
	Assessing Sleep Disorders	719
PART H	INTRAOPERATIVE MONITORING
42	Cerebral Function Monitoring Elson L. so and Frank W. Sharbrough	727
	Introduction	727
	Technical Factors in Intraoperative EEG Monitoring	727
	Effects of Anesthesia on Electroencephalography Symmetrical EEG Patterns during Anesthesia	731
	Preoperative Focal Abnormalities Seen with Anesthesia	732
	Clinical Applications	733
	EEG Changes during Carotid Endarterectomy	733
	Sep Recording during Carotid Endarterectomy	735
	Other Monitoring Techniques during Carotid Endarterectomy	735
	EEG Monitoring during Cardiac Surgery	736
	Bispectral Analysis of EEG for Monitoring Depth of Anesthesia	736
	EEG Monitoring for Epilepsy Surgery	736
43	Brain Stem and Cranial Nerve Monitoring Brian A. Crum	739
	Introduction	739
	Methods	740
	Applications	743
44	Spinal Cord Monitoring Jeffrey A. Strommen	751
	Introduction	751
	General Principles of Intraoperative Monitoring	752
	Equipment and Electrical Safety	753
	Monitoring Methods—Somatosensory Evoked Potentials	754
	Motor Evoked Potentials	760
	Electromyography and Nerve Conduction Studies	765
	Types of Spinal Surgeries	768
45	Peripheral Nervous System Monitoring C. Michel Harper, Jr.	777
	Introduction	777
	Methods	778
	Applications	780
SECTION 3	APPLICATIONS OF CLINICAL NEUROPHYSIOLOGY: ASSESSING SYMPTOM COMPLEXES AND DISEASE ENTITIES
46	Assessing Central Nervous System Symptoms Elson L. So	791
	Introduction	791
	Assessment of Motor Symptoms of Central Origin	791
	Assessment of Sensory Symptoms of Central Origin	792
	Assessing Impairment of Consciousness and Cognition	792
	Assessing Impairment of Visceral Function and Sleep	792
	Identifying Disease Types	793
	Prognosis	793
	Assessing Clinical Disorders with EEG	793
47	Application of Clinical Neurophysiology: Assessing Peripheral Neuromuscular Symptom Complexes Devon L. Rubin and Jasper R. Daube	801
	Clinical Neurophysiology in the Assessment of Peripheral Nervous System Disorders	802
	Assessing Clinical Disorders: Assessment with EMG and NCS	806
	Radiculopathies	806
	Common Focal Mononeuropathies	808
	Peripheral Neuropathy	810
	Brachial Plexopathy	817
	Generalized Weakness	822
	Myopathy	823
	Myalgias, Muscle Stiffness, and Episodic Muscle Weakness	827
	NMJ Disorders	827
	Polyradiculopathy	829
	Motor Neuron Disease	830
	Facial Weakness	831
	Anomalous Innervation	831
	Unexpected Findings on Nerve Conduction Studies: Cause and Action	835
	Glossary of Electrophysiologic Terms	839
	Index	869