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The Guidelines for Qualifications of Neurodiagnostic Personnel (QNP) document has been created through the collaboration of the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and ASET The Neurodiagnostic Society (ASET). The quality of patient care is optimized when neurophysiological procedures are performed and interpreted by appropriately trained and qualified practitioners at every level. These societies recognize that neurodiagnostics is a large field with practitioners who have entered the field through a variety of training paths. This document suggests job titles, associated job responsibilities, and the recommended levels of education, certification, experience, and ongoing education appropriate for each job. This is important because of the growth and development of standardized training programs, board certifications, and continuing education in recent years. This document matches training, education, and credentials to the various tasks required for performing and interpreting neurodiagnostic procedures. This document does not intend to restrict the practice of those already working in neurodiagnostics. It represents recommendations of these societies with the understanding that federal, state, and local regulations, as well as individual hospital bylaws, supersede these recommendations. Because neurodiagnostics is a growing and dynamic field, the authors fully intend this document to change over time., (Copyright © 2023 The Author(s). Published by Wiley Periodicals LLC on behalf of American Association of Neuromuscular & Electrodiagnostic Medicine, Inc.)

This revision to the EEG Guidelines is an update incorporating current EEG technology and practice. The role of the EEG in making the determination of brain death is discussed as are suggested technical criteria for making the diagnosis of electrocerebral inactivity.

This revision to the EEG Guidelines is an update incorporating the current electroencephalography technology and practice. It was previously published as Guideline 2. Similar to the prior guideline, it delineates the aspects of Guideline 1 that should be modified for neonates and young children. Recording conditions for photic stimulation and hyperventilation are revised to enhance the provocation of epileptiform discharges. Revisions recognize the difficulties involved in performing an EEG under sedation in young children. Recommended neonatal EEG montages are displayed for the reduced set of electrodes only since the montages in Guideline 3 should be used for a 21-electrode 10-20 system array. Neonatal documentation is updated to use current American Academy of Pediatrics term "postmenstrual age" rather than "conceptional age." Finally, because therapeutic hypothermia alters the prognostic value of neonatal EEG, the necessity of documenting the patient's temperature at the time of recording is emphasized.

This revision to the EEG Guidelines is an update incorporating current EEG technology and practice. "Standards of practice in clinical electroencephalography" (previously Guideline 4) has been removed. It is currently undergoing revision through collaboration among multiple medical societies and will become part of "Qualifications and Responsibilities of Personnel Performing and Interpreting Clinical Neurophysiology Procedures." The remaining guidelines are reordered and renumbered.

Neurophysiologic monitoring during surgical procedures involving the aortic arch is very complex because of the number of different phases of the procedure, the high mortality rate, and the use of hypothermia. In this paper, the critical goals of neurophysiologic monitoring are discussed in the context of the different surgical events and the surgical options during the different phases of the procedure. These include establishing a neurophysiologic baseline and identifying any evidence of cerebral ischemia that might suggest a reduction in cerebral perfusion. The role of EEG and evoked potentials in assessing the effect of hypothermia and circulatory arrest is also discussed. As these effects are predictable in large part, the neurophysiologist will be able to determine when changes in the neurophysiologic tests outside the norm occur and provide prompt warnings to the surgeon.

Objective. There are two objectives of this study. The first is to understand how practitioners of differing backgrounds approach the process of interpreting intra-operative neurophysiologic monitoring. The second is to understand whether the experience and educational background of practitioners influences the degree of agreement in their interpretations. Methods. A survey was distributed at the 2004 American Society of Neurophysiological Monitoring meeting. A total of 92 responses were obtained. The effect that various characteristics of the respondents including their experience, degree, certification and role in monitoring had on a number of outcome measures was assessed. These outcome measures included the probability that the surgeon responded to a warning, the chance that the patient would wake without a deficit after a warning was delivered, and the degree to which respondents agreed on interpretations of SSEP traces. Results. It was found that surgeons were more likely to respond to warnings issued by a monitrist with a higher degree of experience. Respondents with higher levels of experience, certification level, and degree level were more likely to agree on interpretations of evoked potential tracings. Overall, however, the degree of agreement between respondents was at most moderate. Respondents with higher levels of experience and training were more likely to provide correct answers to a subset of traces that were designed to reflect a classic pattern of change. Conclusions. This study indicates the need for additional studies on the criteria for providing warnings during IOM and the characteristics of monitrists that influence their interpretations.

The American Society of Neurophysiological Monitoring (ASNM) is developing position statements aimed at assisting practitioners and others in making decisions regarding neurophysiological monitoring practice. This paper describes the procedures used in drafting these documents.

Although dementia is a common and devastating disease that has been studied intensely for more than 100 years, no effective disease modifying treatment has been found. At this impasse, new approaches are important. The purpose of this paper is to provide, in the context of current research, one clinician's perspective regarding important challenges in the field in the form of specific challenges. These challenges not only illustrate the scope of the problems inherent in finding treatments for dementia, but can also be specific targets to foster discussion, criticism and new research. One common theme is the need to transform research activities from small projects in individual laboratories/clinics to larger multinational projects, in which each clinician and researcher works as an integral part. This transformation will require collaboration between researchers, large corporations, regulatory/governmental authorities and the general population, as well as significant financial investments. However, the costs of transforming the approach are small in comparison with the cost of dementia. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Quantify how temperature and age modulate the effects of multiple periods of anoxia on peripheral nerve. Methods: Nerve action potentials (NAP) recorded from rat sciatic nerve in vitro. Effects of multiple cycles of anoxia on the NAP are evaluated as functions of temperature and age. In some experiments, the nerve was held at constant temperature and others the nerve was hypothermic only during anoxia and returned to 36°C with restoration of oxygen. Results: Hypothermia mitigates the effect of anoxia on the NAP, an effect that increases with multiple cycles of anoxia. Preservation of the NAP waveform after 5 cycles of anoxia is best when hypothermia is delivered only during anoxia. Hypothermia reduces the rate at which the NAP disappears during anoxia but has a limited effect on the rate of recovery. With intermittent hypothermia the amplitude of the NAP is best preserved with temperatures of 15–22°C. Velocity and duration are best preserved below 25°C. The loss of the NAP during anoxia is slower in the older nerves. Conclusions: Lower temperatures improve the recovery of the NAP from anoxia and increase the time it takes for the NAP to disappear during anoxia as does increasing age. Significance: Document the effects of hypothermia on the anoxia response as a step toward understanding its nerve protectant effect. [Copyright &y& Elsevier]

Abstract: Objective: Determine the effects of serial episodes of anoxia in an in vitro peripheral nerve preparation. Methods: The nerve action potential (NAP) from rat sciatic nerve was recorded during 5 cycles of anoxia and reperfusion. Multiple NAP parameters were analyzed as well as stimulus response curves. Results: The amplitude of the NAP declined to half baseline in 865s on the first cycle of anoxia and recovered to half baseline during recovery in 470s. These times increased with successive cycles of anoxia. The current required to produce a half maximal NAP showed a variable initial decrease before increasing with anoxia. The paired-pulse response showed a decline at 2–3ms interstimulus interval during anoxia but was less dependent of interstimulus interval during recovery. NAP amplitude and velocity decrease over successive cycles of anoxia at a rate greater than in the absence of anoxia. Conclusions: The NAP declines slowly when peripheral nerve is exposed to anoxia but returns at least twice as quickly when re-exposed to oxygen. Short periods of anoxia produce long lasting changes in the nerve suggesting greater resistance to anoxia. With serial episodes of anoxia there is gradual NAP amplitude reduction and increase in duration and latency. Significance: Anoxic-preconditioning appears in isolated peripheral nerve. [Copyright &y& Elsevier]

Detecting acute nerve compression using neurophysiologic studies is an important part of the practice of clinical intra-operative neurophysiology. The goal of this paper was to study the changes in the compound muscle action potential (CMAP) during acute mechanical compression. This is the type of injury most likely to occur during surgery. Thus, understanding the changes in the CMAP during this type of injury will be useful in the detection and prevention using intra-operative neurophysiologic monitoring. The model involved compression of the hamster sciatic nerve over a region of 1.3 mm with pressures up to 2000 mmHg for times on the order of 3 minutes. In this model CMAP amplitude dropped to 50% of its baseline value when a pressure of roughly 1000 mmHg is applied while, at the same time, nerve conduction velocities decline by only 5%. The ability to detect statistically significant changes in the CMAP at low force levels using other descriptors of the CMAP including duration, latency variation, etc alone or in conjunction with amplitude and velocity measures was investigated. However, these other parameters did not allow for earlier detection of significant changes. This study focused on a model in which nerve injury on a short time scale is purely mechanical in origin. It demonstrated that a pure compression injury produced large changes in CMAP amplitude prior to large changes in conduction velocity. On the other hand, ischemic and stretch injuries are associated with larger changes in conduction velocity for a given value of CMAP amplitude reduction. [ABSTRACT FROM AUTHOR]