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The high physiologic demands of sports create dynamic stress on joints, soft tissues, and nerves which may lead to injuries in the athlete. Electrodiagnostic (EDx) assessment is essential to identify the correct diagnosis, localization, and prognosis, to guide management of sports‐related neuropathies. A comprehensive review was performed to provide the EDx medical consultant with a practical approach to the common peripheral nerve disorders seen in athletes. Sports‐related neuropathies reviewed include transient traumatic irritation of the brachial plexus and/or cervical nerve roots (“Burners and stingers,”) suprascapular and axillary neuropathies, ulnar neuropathy at the elbow (UNE) in throwers, ulnar neuropathy at the hand/wrist in cyclists, multi‐ligamentous knee injury, and foot/ankle neuropathies including tarsal tunnel syndrome. A thorough understanding of peripheral anatomy, possible entrapment sites, mechanisms of injury, and key physical examination findings is essential for correct diagnosis. EDx assessments beyond routine studies are generally required for sports‐related neuropathy, which may not necessarily follow typical entrapment patterns. Adjunct diagnostic imaging, such as point‐of‐care ultrasound and magnetic resonance imaging, are helpful tools to identify associated musculoskeletal pathology such as compressive cysts or nerve entrapment, which may be amenable to interventional or surgical treatment. When no clear reversible structural pathology exists, management of sports‐related neuropathy is athlete‐specific and generally multi‐modal, involving a combination of physical rehabilitation techniques to address muscle imbalances, load management, protective equipment, and interventional pain procedures. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to characterize the electrodiagnostic findings of radial neuropathy using motor segmental conduction study and to determine the utility of subsequent inching test in precise lesion localization. Design: Twenty-three patients with radial neuropathy were evaluated using radial neuropathy using motor segmental conduction study with three-point stimulation. The pathomechanism of the lesions according to the radial neuropathy using motor segmental conduction study was classified into three groups: conduction block, mixed lesion (combination of conduction block and axonal degeneration), and axonal degeneration. Inching test was performed in patients with conduction block to localize the lesion site, and needle electromyography identified the most proximal radial nerve-innervated muscles affected. Results: Out of 23 cases, the radial neuropathy using motor segmental conduction study demonstrated probable partial conduction block in 10, mixed lesions in 2, and axonal degeneration in 10. One case could not be categorized with radial neuropathy using motor segmental conduction study alone. As determined by radial neuropathy using motor segmental conduction study and inching test, the most common cause of conduction block was compression, while the most common cause of axonal degeneration was iatrogenic. In the conduction block group, the lesion locations identified by radial neuropathy using motor segmental conduction study and inching test were consistent with needle electromyography localization. Conclusions: The combined radial neuropathy using motor segmental conduction study and inching test technique can precisely localize radial motor nerve injuries and provide detailed information on electrodiagnostic characteristics of radial mononeuropathy [ABSTRACT FROM AUTHOR]

Background: Neuromuscular ultrasound plays an increasing role in diagnosing carpal tunnel syndrome (CTS). There are limited data supporting the correlation between the electrodiagnostic studies and ultrasound measurements in CTS. Objective: To assess the association between different electrodiagnostic severities and ultrasound measurements of the median nerve in CTS. Design: A retrospective cohort study. Setting: An academic tertiary care center. Patients: Patients 18 years or older evaluated with upper limb electrodiagnostic studies and neuromuscular ultrasound. Main outcome measurement: Ultrasound measurements of the median nerve cross‐sectional area (CSA) at the wrist and the calculated wrist‐to‐forearm ratio (WFR) were compared with the electrodiagnostic severity (normal, mild, moderate, and severe). Mean analysis and analysis of variance test (α = 0.05) were performed to assess the association. Results: A total of 1359 limbs were identified. There was a statistically significant association between electrodiagnostic severity of CTS and median nerve CSA at the wrist (p <.001), as well as the WFR (p <.001). The mean median nerve CSA at the wrist and WFR were 7.01 ± 2.06 mm2 (95% CI: 6.80–7.20) and 1.24 ± 0.36 (95% CI: 1.16–1.24) in electrodiagnostically normal median nerves, 10.47 ± 2.82 mm2 (95% CI: 10.25–10.75) and 2.06 ± 0.67 (95% CI: 2.04–2.16) in electrodiagnostically mild CTS, 12.95 ± 4.74 mm2 (95% CI: 12.41–13.59) and 2.49 ± 1.04 (95% CI: 2.37, 2.63) in electrodiagnostically moderate CTS, and 14.69 ± 5.38 mm2 (95% CI: 13.95–15.44) and 2.71 ± 1.02 (95% CI: 2.56–2.84) in electrodiagnostically severe CTS, respectively. Conclusion: This study suggests a direct association between electrodiagnostic severity and ultrasound measurements of the median nerve in patients with suspected CTS. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome. Methods: In this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm. Results: In this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05). Conclusion: Based on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly. [ABSTRACT FROM AUTHOR]

Background: Electrodiagnosis is a localizing, diagnostic, and prognostic tool for individuals with suspected neuromuscular diseases. In addition to detailed history taking and thorough clinical examination, correct execution and interpretation of these tests can provide vital insights into the underlying neuromuscular disorders and frequently guide the need for proper management decision. The request for an electrodiagnosis examination should include brief clinical information and a provisional clinical diagnosis; this enhances the efficient easy performance of the test. The current study aims to detect the pattern of neuromuscular diseases in the Alexandria Main University Hospital, Egypt, and to evaluate the quality of the referral system to the electrodiagnosis unit. Results: The study included 371 patients, out of which, 65% were referred from the Governmental Specialized Medical Councils and the Neurosurgery department. Although sensory complaints were the main reason for referral, yet 28.8% of patients did not show any electrodiagnosis abnormality. A compatible referral note led to shorter test times and fewer electromyography needle insertions. Conclusion: Disorders of the peripheral nerves are the most frequent neuromuscular diseases referred to the electrodiagnosis unit with carpal tunnel syndrome being the most common disorder. A compatible referral letter is necessary when requesting an electrodiagnosis test, to save the physician time and focus on targeted procedures. [ABSTRACT FROM AUTHOR]

Introduction: The revised international standards for neurological classification of spinal cord injury (ISNCSCI) have facilitated the documentation of non‐spinal cord injury‐related impairments, such as chronic peripheral nerve injuries and muscle weakness due to immobility. This advancement addresses potential biases in muscle strength examinations. Utilizing electrically evoked contractions from paralyzed muscles, enhanced by electrodiagnosis, holds promise in identifying false‐negative diagnoses of non‐responsiveness to neuromuscular electrical stimulation. This concept prompts the exploration of polyneuromyopathy arising from nonuse in paralyzed muscles. Case Series Presentation: To substantiate our hypothesis, we recruited nine participants for a case series aimed at elucidating the potential benefits of incorporating the stimulus electrodiagnostic test (SET) to mitigate non‐responsiveness during preparation for functional electrical stimulation (FES)‐assisted cycling. In our convenience sample (n = 5), we conducted neurological mapping based on ISNCSCI and applied SET on the quadriceps. The SET guided optimal dosimetry for evoking contractions and revealed responses similar to those observed in peripheral neuropathies, with α coefficients equal to or lower than 2.00. This observation is likely attributable to nonuse of paralyzed muscles, indicative of an ongoing polyneuropathy in individuals with chronic spinal cord injury (SCI). Discussion: Among the nine initially recruited subjects, seven exhibited responsiveness to neuromuscular electrical stimulation (78% responsiveness), with two participants excluded based on exclusion criteria. In the final five reported cases, all displayed α coefficient values indicating impaired neuromuscular accommodation, and one presented no α coefficient within the normal range. The inclusion of electrodiagnosis appears effective in averting non‐responsiveness, suggesting the presence of ongoing polyneuropathies in paralyzed muscles. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Diagnostic criteria for multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensorimotor neuropathy (MADSAM) require the involvement of at least two peripheral nerves. However, many patients with very similar features have clinical involvement of only a single peripheral nerve, which may preclude their correct diagnosis and treatment. The present study aimed to present a cohort of such patients and discuss the role of ultrasonography (US) in their diagnosis. Methods: Patients with nonvasculitic immune‐mediated motor mononeuropathies (MM) and sensorimotor mononeuropathies (SMM) were recruited prospectively or identified from the electronic records. They were invited to comprehensive follow‐up visits consisting of clinical examination, electrodiagnostic (EDx), and US studies. Results: Twenty‐four patients (13 men) were studied (11 with MM). The characteristics of MM and SMM patients were very similar to MMN and MADSAM, respectively. The US, in addition to a long‐swollen segment (average length, 20 cm) in the clinically affected nerve, revealed nerve swelling in, on average, six additional sites in clinically unaffected nerves. Discussion: In patients with clinical and EDx involvement of only a single nerve, an US demonstration of multifocal peripheral nerve swelling points to a more widespread, probably dysimmune mechanism. Further studies are needed to evaluate the value of US as a supplementary method for the diagnosis of MADSAM and MMN in patients with clinical involvement of a single nerve. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Using a set of process‐of‐care quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome (CTS), the research team previously documented large variations in electrodiagnostic testing practices and adherence to quality measures. This study sought to enhance the applicability and validity of the quality measures by integrating acceptable variations in testing practices. Methods: We recruited 13 expert electrodiagnostic medicine specialists from five specialty societies. The experts iteratively refined five quality measures, and then rated the validity of the refined quality measures (1–9 scale). During this process, the experts reviewed data on adherence to existing quality measures and variations in electrodiagnostic testing practices, and considered recently published quality measures from the American Association of Neuromuscular and Electrodiagnostic Medicine. Results: Three quality measures (electrodiagnostic testing before surgery for CTS, temperature assessment during electrodiagnostic testing, and electrodiagnostic criteria for severe median neuropathy) underwent few refinements and were rated valid (medians 8–9). Two measures (essential components of electrodiagnosis, criteria for interpreting electrodiagnostic tests as median neuropathy) were judged valid (medians 8) after revisions. For these measures, experts' ratings on the recommended components of sensory or mixed nerve conduction studies varied: agreement among the experts about the use of sensory peak latency was greater than for onset latency or sensory velocity. Discussion: This study produced quality measures that provide minimum standards for electrodiagnostic testing for suspected CTS that are more comprehensive and nuanced than prior versions. Future work can assess the feasibility, reliability, and validity of these refined measures in diverse physician practices. [ABSTRACT FROM AUTHOR]

BACKGROUND: An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity. OBJECTIVE: This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS. METHODS: This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens' classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation were performed to detect anatomical abnormalities. RESULTS: Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group. CONCLUSION: The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups. [ABSTRACT FROM AUTHOR]

Although real-time event detection during video EEG recording is required to ensure patients' safety, it is limited by the technologists' availability. We sought to explore the efficiency of real-time event detection by the EEG technologists in a single tertiary academic center. We retrospectively reviewed events from continuous inpatient video EEGs (cEEGs) and epilepsy monitoring unit (EMU) recordings in January 2017, when real-time surveillance was only available during the night shift, and June 2017, when a dedicated neurodiagnostic EEG technologist was available for real-time monitoring during all shifts. The events were categorized into those detected immediately (eyes-on), later in the same shift (delayed) or identified on the subsequent shift (missed). Chi-square and Fisher's exact tests were used for statistical comparisons. In January 2017, there were 25 patients (117 days of monitoring) in the EMU and 54 inpatients (146 days of monitoring) on cEEG with 92 total events, (39% seizures). In June 2017, there were 30 patients (133 days of monitoring) in the EMU and 47 additional inpatients (80 days of monitoring) on cEEG with 110 total events, (39% seizures). The number of events identified in real time was low and did not significantly differ among shifts regardless of the availability of the monitoring technologist. Most events were identified at the time of subsequent EEG scanning by the EEG technologist. Partial staffing for continuous video EEG surveillance is insufficient to identify events in real time. EEG technologists are able to identify events during regular EEG scanning. [ABSTRACT FROM AUTHOR]

Background and purpose: Various electrodiagnostic criteria have been developed in Guillain–Barré syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria. Methods: From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally. Results: Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%. Conclusions and discussion: This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted. [ABSTRACT FROM AUTHOR]

Background: A quantitative approach to predict expected muscle activity and mandibular movement from non‐invasive hard tissue assessments remains unexplored. Objectives: This study investigated the predictive potential of normalised muscle activity during various jaw movements combined with temporomandibular joint (TMJ) vibration analyses to predict expected maximum lateral deviation during mouth opening. Method: Sixty‐six participants underwent electrognathography (EGN), surface electromyography (EMG) and joint vibration analyses (JVA). They performed maximum mouth opening, lateral excursion and anterior protrusion as jaw movement activities in a single session. Multiple predictive models were trained from synthetic observations generated from the 66 human observations. Muscle function intensity and activity duration were normalised and a decision support system with branching logic was developed to predict lateral deviation. Performance of the models in predicting temporalis, masseter and digastric muscle activity from hard tissue data was evaluated through root mean squared error (RMSE) and mean absolute error. Results: Temporalis muscle intensity ranged from 0.135 ± 0.056, masseter from 0.111 ± 0.053 and digastric from 0.120 ± 0.051. Muscle activity duration varied with temporalis at 112.23 ± 126.81 ms, masseter at 101.02 ± 121.34 ms and digastric at 168.13 ± 222.82 ms. XGBoost predicted muscle intensity and activity duration and scored an RMSE of 0.03–0.05. Jaw deviations were successfully predicted with a MAE of 0.9 mm. Conclusion: Applying deep learning to EGN, EMG and JVA data can establish a quantifiable relationship between muscles and hard tissue movement within the TMJ complex and can predict jaw deviations. [ABSTRACT FROM AUTHOR]

Abstract Introduction Carpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome. Methods In this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm. Results In this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value

Abstract Background Electrodiagnosis is a localizing, diagnostic, and prognostic tool for individuals with suspected neuromuscular diseases. In addition to detailed history taking and thorough clinical examination, correct execution and interpretation of these tests can provide vital insights into the underlying neuromuscular disorders and frequently guide the need for proper management decision. The request for an electrodiagnosis examination should include brief clinical information and a provisional clinical diagnosis; this enhances the efficient easy performance of the test. The current study aims to detect the pattern of neuromuscular diseases in the Alexandria Main University Hospital, Egypt, and to evaluate the quality of the referral system to the electrodiagnosis unit. Results The study included 371 patients, out of which, 65% were referred from the Governmental Specialized Medical Councils and the Neurosurgery department. Although sensory complaints were the main reason for referral, yet 28.8% of patients did not show any electrodiagnosis abnormality. A compatible referral note led to shorter test times and fewer electromyography needle insertions. Conclusion Disorders of the peripheral nerves are the most frequent neuromuscular diseases referred to the electrodiagnosis unit with carpal tunnel syndrome being the most common disorder. A compatible referral letter is necessary when requesting an electrodiagnosis test, to save the physician time and focus on targeted procedures.

The normal functioning of every cell in the body depends on its bioelectric properties and many diseases are caused by genetic and/or epigenetic dysregulation of the underlying ion channels. Metastasis, the main cause of death from cancer, is a complex multi-stage process in which cells break away from a primary tumour, invade the surrounding tissues, enter the circulation by encountering a blood vessel and spread around the body, ultimately lodging in distant organs and reproliferating to form secondary tumours leading to devastating organ failure. Such cellular behaviours are well known to involve ion channels. The CELEX model offers a novel insight to metastasis where it is the electrical excitation of the cancer cells that is responsible for their aggressive and invasive behaviour. In turn, the hyperexcitability is underpinned by concomitant upregulation of functional voltage-gated sodium channels and downregulation of voltage-gated potassium channels. Here, we update the in vitro and in vivo evidence in favour of the CELEX model for carcinomas. The results are unequivocal for the sodium channel. The potassium channel arm is also broadly supported by existing evidence although these data are complicated by the impact of the channels on the membrane potential and consequent secondary effects. Finally, consistent with the CELEX model, we show (i) that carcinomas are indeed electrically excitable and capable of generating action potentials and (ii) that combination of a sodium channel inhibitor and a potassium channel opener can produce a strong, additive anti-invasive effect. We discuss the possible clinical implications of the CELEX model in managing cancer. [ABSTRACT FROM AUTHOR]

Background Electrodiagnostic testing (EDX) is important in the diagnosis and follow-up of neuropathic and myopathic diseases. This study aimed to demonstrate the compatibility between clinical prediagnosis and electrophysiological findings. Methods EDX results from 2004 to 2020 at the physical medicine and rehabilitation (PM&R) clinic were screened. Tests with missing data, reevaluation studies, and cases of peripheral facial paralysis were excluded. The clinical prediagnosis and EDX results were recorded, and their compatibility was evaluated. Results A total of 2,153 tests were included in this study. The mean age was 49.0±13.9 years and 1,533 of them (71.2%) were female. The most frequently referred clinic was the PM&R clinic (90.0%). Numbness (73.6%) was the most common complaint, followed by pain (15.3%) and weakness (13.9%). The most common prediagnosis was entrapment neuropathy (55.3%), radiculopathy (16.1%), and polyneuropathy (15.7%). Carpal tunnel syndrome was the most frequently identified type of entrapment neuropathy (78.3%). Six hundred and seventy EDX results (31.1%) were within normal limits. While the EDX results were consistent with the prediagnosis in 1,328 patients (61.7%), a pathology different from the prediagnosis was detected in 155 patients (7.2%). In the discrepancy group, the most common pathologies were entrapment neuropathy (51.7%), polyneuropathy (17.3%), and radiculopathy (15.1%). The most common neuropathy type was carpal tunnel syndrome (79.3%). Conclusion After adequate anamnesis and physical and neurological examinations, requesting further appropriate tests will increase the prediagnosis accuracy and prevent unnecessary expenditure of time and labor.

Entrapment neuropathy of the ulnar nerve at the elbow, the so-called cubital tunnel syndrome, is the second most frequent focal mononeuropathy after carpal tunnel syndrome in adults. Currently, there is a pressing need to identify cost-effective biomarkers and procedures capable of accurately detecting alterations in ulnar nerve structural and functional integrity. Established electrophysiological techniques, such as motor and sensory nerve conduction studies, along with needle electromyography of specific muscles, represent the gold standard for ulnar nerve electrodiagnosis. Concurrently, the introduction of neuromuscular ultrasound and its integration into electromyographic laboratories has significantly impacted structural diagnosis and the precise localization of ulnar nerve pathology over the past two decades. In this review, our objective is to summarize the current knowledge on both classical and advanced diagnostic methods utilized in clinical neurophysiology laboratories. We aim to provide a synthesis of modern electrodiagnostic and neurosonographic techniques, with a particular emphasis on easily attainable, clinically relevant parameters. [ABSTRACT FROM AUTHOR]

The article focuses on the utility of electromyography (EMG) in diagnosing rhabdomyolysis, a condition characterized by acute muscle necrosis. Topics include the prevalence and common causes of rhabdomyolysis; the role of EMG in identifying myopathic changes; and the limitations of EMG compared to genetic testing and muscle biopsy for definitive diagnosis.

Purpose: To investigate whether a novel electropalatography (EPG) therapy, underpinned by usage-based phonology theory, can improve the accuracy of target speech sounds for school-aged children and adults with persistent speech sound disorder (SSD) secondary to cleft palate +/− lip. Method: Six consecutively treated participants (7–27 years) with long-standing speech disorders associated with cleft palate enrolled in a multiple baseline (ABA) within-participant case series. The usage-based EPG therapy technique involved high-volume production of words. Speech was assessed on three baselines prior to therapy, during weekly therapy, at completion of therapy, and 3 months post-therapy. Percent correct of target phonemes in untreated words and continuously connected speech were assessed through acoustic phonetic transcription. Intra- and inter-transcriber agreement was determined. Result: Large to medium treatment effect sizes were shown for all participants following therapy (15–33 sessions). Percentage of targets correct for untreated words improved from near 0% pre-therapy, to near 100% for most target sounds post-therapy. Generalisation of target sounds to spontaneous connected speech occurred for all participants and ranged from 78.95−100% (M = 90.66; SD = 10.14) 3 months post-therapy. Conclusion: Clinically significant speech change occurred for all participants following therapy. Response to the novel therapeutic technique is encouraging and further research is indicated. [ABSTRACT FROM AUTHOR]

Objectives: To develop a clinical instrument to assess carpal tunnel syndrome (CTS) severity before electrodiagnostic testing. Methods: Data from 1037 patients with CTS (39.1% male) were included. The mean (SD) age was 58.0 (10.8) years. The severity of CTS was based on electrodiagnostic findings. Results: We devised a composite index incorporating a pain numeric rating scale (NRS) rated from 0 (no pain at all) to 10 (the worst pain ever possible), thenar muscle weakness or atrophy (TW), cross-sectional area (CSA) of the median nerve (mm2), and nocturnal pain (NP). The index was calculated as [scale(NRS)+scale(CSA)+NP+TW]/4, where NP and TW are binary features (0 or 1). The accuracy and area under the curve of the index were 0.85 and 0.71, respectively (Cohen's Kappa = 0.51, McNemar's test P = 0.249). The index increased pretest probabilities by 1.6, 1.8, and 3.3 times with positive likelihood ratios of 3.3, 2.5, and 13.5, and false-positive rates of 26.6, 17.6, and 4.8% for mild, moderate, and severe CTS, respectively. The index thresholds for mild, moderate, and severe CTS were <0.8, ≥0.8 to <1.1, and ≥1.1, respectively. Conclusion: Using a composite index, patients with CTS can be categorized for the severity of the syndrome. [ABSTRACT FROM AUTHOR]

The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of sensorimotor training on gait, ankle joint proprioception, and quality of life in diabetic peripheral neuropathy patients. Design: A prospective, single-blind, randomized controlled experiment was performed. Forty patients with diabetic peripheral neuropathy aged 50–65 yrs were distributed randomly into two groups, the sensorimotor training group (n = 20), and the control group (n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 mins, every 2 wks. Moreover, the sensorimotor training group received 6 wks (3 d/wk) of sensorimotor training. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 wks of intervention. Results: Regarding baseline data, no significant differences were identified among groups (P > 0.05). After 6-wk intervention, the sensorimotor training group exhibited significant improvements in all outcome variables (P < 0.001), while the control group showed significant changes in quality of life only (P = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the sensorimotor training group (P < 0.001). Conclusions: Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with diabetic peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Objectives: To explore the correlation between classification and electrophysiology of polyneuropathy, organmegaly, endocrinopathy, M-protein, skin changes syndrome (POEMS)-related peripheral neuropathy (PN). Methods: We analyzed the data of 30 POEMS patients admitted to Zhongshan Hospital affiliated with Fudan University between February 2017 and February 2023. The degree of PN was determined according to its classification. All three groups of patients underwent neuroelectromyography, and the nerve conduction velocity and amplitude of the three groups were analyzed. Results: The compound motor active potentials (CMAP) of the peroneal, tibial, and ulnar nerves decreased significantly with increasing disease grade, and the motor conduction velocity of the peroneal, median, and tibial nerves decreased significantly in grade 3 compared with grade 1 and 2. The action potential of sensory nerves (sensory nerve action potential) and the conduction speed of sensory impulses (sensory conduction velocity (SCV) in the sural nerve in grade 3 were significantly lower than those in grades 1 and 2. Linear regression analysis showed that there was a linear correlation between CMAP of peroneal nerve and vascular endothelial growth factor. The SCV of the ulnar nerve significantly correlated with the course of the disease. Discussion: Neuroelectromyography can effectively evaluate the degree of PN in patients with POEMS, providing a reliable reference for further clinical treatment. [ABSTRACT FROM AUTHOR]

With advances in the surgical management for severe ulnar neuropathy with the introduction of the super charged-end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfer, a simple and reliable outcome measure is required. There is currently not "one" standardized outcome measure used to represent and compare results. To present the abduction hand diagram as a "novel", reproducible, and simple outcome measure for patients with severe ulnar neuropathy. Retrospective case series. Nine patients with severe entrapment/compressive ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative abduction tracings, Medical Research Grade (MRC) muscle strength, key pinch strength, Disability of the Hand Arm and Shoulder (DASH) score, and crossed finger test. Electrodiagnostic data included change in compound muscle action potentials (CMAP) amplitude of the first dorsal interosseous (FDI), and abductor digiti minimi (ADM). Summary statistics were used for demographic and clinical data. Average follow-up was 22.8 ± 9.3 months. At 18-months of follow up, 44% had ADM MRC grade 3 strength or higher, mean key pinch strength improved to 72 ± 19.3%, and mean DASH was 33 ± 28.7. There was a mean increase of 16.7 ± 9.1 mm and 31.5 ± 12 mm in total and summed hand abduction tracing measurements respectively. Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function and can be used in patients with severe ulnar neuropathy following surgical intervention. • Hand abduction tracings are an outcome measure that can be used to assess intrinsic motor hand function recovery for patients undergoing ulnar nerve surgery. • Hand abduction tracings should be used in future supercharged end to side anterior interosseus nerve to ulnar nerve transfer studies to allow for standardization and comparison. [ABSTRACT FROM AUTHOR]

Functional tremor is the most common subtype of functional movement disorder (FMD). At present, there is no "gold standard" for diagnosis. Most clinical manifestations coincide with organic tremor, which can easily lead to misdiagnosis and mistreatment. Characteristic electrophysiological manifestations can provide objective and repeatable diagnostic information, effectively supplement the history and physical examination, and can also be used in the differential diagnosis from organic tremor. This article reviews the electrophysiological characteristics of functional tremor and its application in diagnosis and differential diagnosis, in order to improve the clinical understanding of this disease. [ABSTRACT FROM AUTHOR]

At the inner rear portion of the foot is a tunnel through which a nerve, blood vessel, and several tendons pass. As long as the foot and ankle function in a balanced manner, this tunnel and its neurovascular bundle create no problems. If, however, the ankle and foot become imbalanced in a particular and measurable way, the fibrous band that covers the tunnel becomes stretched and interferes with both normal nerve function and circulation. This area is known as the tarsal tunnel. A narrowing of the tunnel follows foot pronation, an extremely common human problem, which is an inward rolling of the ankle and foot. Unfortunately, when the problem first develops it usually does not cause symptoms. If symptoms such as pain or numbness developed immediately, the individual would recognise a problem and seek treatment. Manual muscle testing of the muscles that move the foot permits the earliest diagnosis of this oncoming problem to occur and saves many patients from enormous troubles. The muscular analysis offered by chiropractic manual muscle testing are the very muscles that help support the bones during activity to avoid narrowing of the tarsal tunnel. [ABSTRACT FROM AUTHOR]

(1) Background: The diagnosis of lumbosacral radiculopathy involves anamnesis, an assessment of sensitivity and strength, diagnostic imaging—usually magnetic resonance imaging (MRI)—and electrodiagnostic testing (EDX), typically electromyography (EMG), and electroneurography (ENG). MRI evaluates the structures supporting the spinal cord, while EDX evaluates root functionality. The present study aimed to analyze the concordance of MRI and EDX findings in patients with clinically suspected radiculopathy. Additionally, we investigated the comparison between these two reference tests and various clinical variables and questionnaires. (2) Methods: We designed a prospective epidemiological study of consecutive cases with an observational, descriptive, cross-sectional, and double-blind nature following the STROBE guidelines, encompassing 142 patients with clinical suspicion of lumbosacral radiculopathy. (3) Results: Of the sample, 58.5% tested positive for radiculopathy using EDX as the reference test, while 45.8% tested positive using MRI. The comparison between MRI and EDX in the diagnosis of radiculopathy in patients with clinical suspicion was not significant; the overall agreement was 40.8%. Only the years with symptoms were comparatively significant between the positive and negative radiculopathy groups as determined by EDX. (4) Conclusion: The comparison between lumbar radiculopathy diagnoses in patients with clinically suspected pathology using MRI and EDX as diagnostic modalities did not yield statistically significant findings. MRI and EDX are complementary tests assessing different aspects in patients with suspected radiculopathy; degeneration of the structures supporting the spinal cord does not necessarily imply root dysfunction. [ABSTRACT FROM AUTHOR]

Active‐duty service members (ADSM) and military Veterans represent a population with increased occupational risk for nerve injuries sustained both during training operations and wartime. Mechanisms of war‐related nerve injuries have evolved over time, from the musket ball‐related traumas described by S.W. Mitchell to complex blast injuries and toxic exposures sustained during Middle East conflicts in the 21st century. Commonly encountered nerve injury etiologies in this population currently include compression, direct trauma, nutritional deficits, traumatic limb amputation, toxic chemical exposures, or blast‐related injuries. Expeditious identification and comprehensive, interdisciplinary treatment of combat‐associated neuropathies, as well as prevention of these injuries whenever possible is critical to reduce chronic morbidity and disability for service members and to maintain a well‐prepared military. However, diagnosis of a combat‐associated nerve injury may be particularly challenging due to comorbid battlefield injuries or delayed presentation of neuropathy from military toxic exposures. Advances in imaging for nerve injury, including MRI and ultrasound, provide useful tools to compliment EMG in establishing a diagnosis of combat‐associated nerve injury, particularly in the setting of anatomic disruption or edema. Surgical techniques can improve pain control or restoration of function. In all cases, comprehensive interdisciplinary rehabilitation provides the best framework for optimization of recovery. Further work is needed to prevent combat‐associated nerve injuries and promote nerve recovery following injury. [ABSTRACT FROM AUTHOR]

A list is presented of newly credentialed technologists, with registration and certification in several fields including electroencephalography, evoked potential technology and neurophysiologic intraoperative monitoring.

The NeuroAnalyst role is relatively new with the NA-CLTM credential first becoming available in 2021. Many institutions express interest in utilizing this new role in neurodiagnostic departments, but there is a relative dearth of information about the benefits and challenges of developing a NeuroAnalyst role to support clinical neurophysiologists. The aim of this article is to share the positive experience of one institution in developing a team of NeuroAnalysts. The addition of the role can decrease EEG report turnaround time and balance the workload of clinical neurophysiologists, which improves patient care and allows physicians to increase productivity in other ways [ABSTRACT FROM AUTHOR]

Introduction: Peripheric nerve hyperexcitability (PNH) syndromes are a rare, heterogenous group of diseases characterized by continuous muscle overactivity due to spontaneous discharges of the lower motor neurons. Case Series: Here we report four patients presented with painful cramps, generalized muscle twitches and lower extremity weakness. All patients had evidence of neuropathy and neuromyotonic discharges on electrodiagnostic studies. Screening for a broad panel of anti-neuronal antibodies proved uncharacterized neuropil antibodies in one patient. Despite extensive serologic and genetic investigations, no definitive etiology was found in our cohort. One out of three patients responded well to immunotherapy. No other diseases including malignancy appeared for 1.5--3 years follow-up duration. Conclusion: Our case series indicate a putatively high prevalence of neuropathy in PNH and emphasize anti-neuronal antibody positivity and early diagnosis as potential favorable prognostic factors. [ABSTRACT FROM AUTHOR]

Purpose: Literature suggests a dependency of the acoustic metrics, smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR), on human voice loudness and fundamental frequency (F0). Even though this has been explained with different oscillatory patterns of the vocal folds, so far, it has not been specifically investigated. In the present work, the influence of three elicitation levels, calibrated sound pressure level (SPL), F0 and vowel on the electroglottographic (EGG) and time-differentiated EGG (dEGG) metrics hybrid open quotient (OQ), dEGG OQ and peak dEGG, as well as on the acoustic metrics CPPS and HNR, was examined, and their suitability for voice assessment was evaluated. Method: In a retrospective study, 29 women with a mean age of 25 years (± 8.9, range: 18–53) diagnosed with structural vocal fold pathologies were examined before and after voice therapy or phonosurgery. Both acoustic and EGG signals were recorded simultaneously during the phonation of the sustained vowels /ɑ/, /i/, and /u/ at three elicited levels of loudness (soft/comfortable/loud) and unconstrained F0 conditions. Results: A linear mixed-model analysis showed a significant effect of elicitation effort levels on peak dEGG, HNR, and CPPS (all p < .01). Calibrated SPL significantly influenced HNR and CPPS (both p < .01). Furthermore, F0 had a significant effect on peak dEGG and CPPS (p < .0001). All metrics showed significant changes with regard to vowel (all p < .05). However, the treatment had no effect on the examined metrics, regardless of the treatment type (surgery vs. voice therapy). Conclusions: The value of the investigated metrics for voice assessment purposes when sampled without sufficient control of SPL and F0 is limited, in that they are significantly influenced by the phonatory context, be it speech or elicited sustained vowels. Future studies should explore the diagnostic value of new data collation approaches such as voice mapping, which take SPL and F0 effects into account. [ABSTRACT FROM AUTHOR]

Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain‐Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities. [ABSTRACT FROM AUTHOR]

Although existing guidelines address electrodiagnostic (EDX) testing in identifying neuromuscular conditions, guidance regarding the uses and limitations of serial (or repeat) EDX testing is limited. By assessing neurophysiological change longitudinally across time, serial electrodiagnosis can clarify a diagnosis and potentially provide valuable prognostic information. This monograph presents four broad indications for serial electrodiagnosis in adult peripheral neurological disorders. First, where clinical change has raised suspicion for a new or ongoing lesion, EDX reassessment for spatial spread of abnormality, involvement of previously normal muscle or nerve, and/or evolving pathophysiology can clarify a diagnosis. Second, where diagnosis of a progressive neuromuscular condition is uncertain, electrophysiological data from a second time point can confirm or refute suspicion. Third, to establish prognosis after a static nerve injury, a repeat study can assess the presence and extent of reinnervation. Finally, faced with a limited initial study (as when complicated by patient or environmental factors), a repeat EDX study can supplement missing or limited data to provide needed clarity. Repeat EDX studies carry certain limitations, however, such as with prognostication in the setting of remote or chronic lesions, sensory predominant fascicular injury, or mild axonal injury. Nevertheless, serial electrodiagnosis remains a valuable and underused tool in the diagnostic and prognostic evaluation of neuromuscular conditions. [ABSTRACT FROM AUTHOR]

BackgroundExtracorporeal shock wave therapy (ESWT), as a non-invasive physical agent modality, was effective in relieving spasticity, reducing pain, and improving dysfunction. This systematic review and meta-analysis aimed to investigate the effect of ESWT on nerve conduction, and to find out whether the ESWT group is superior to the control or other comparison groups, thus providing support for guiding the rehabilitation of peripheral nerve injury in clinical work.MethodsPubMed, Web of Science, the Cochrane Library, and Embase were searched from inception to August 20, 2024. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the PROSPERO database (registration number CRD42024500891). It aimed to compare (1) the ESWT group (ESWT) and baseline, and (2) subgroup analyses: ESWT and the control group (Control), ESWT and the local corticosteroid injection group (LCI), ESWT combined with physical therapy (ESWT + PT) and PT alone, and ESWT and PT. Outcome indicators extracted were nerve conduction study results: sensory nerve action potential (SNAP) amplitude, SNAP distal latency, sensory nerve conduction velocity (SNCV), compound muscle action potential (CMAP) amplitude, motor nerve distal latency (MNDL), motor nerve conduction velocity (MNCV), H/M ratio and H-reflex latency.ResultsA total of 879 papers were identified through the database searches. Twenty-four trials were included in the systematic review, and 22 trials were included in the meta-analysis. The results showed that: (1) compared to the baseline, ESWT reduced SNAP distal latency mid-term (MD, −0.39; 95% CI: −0.52, −0.26; I2 = 85%), and improved SNCV both short-term (MD, 4.36; 95% CI: 1.23, 7.49; I2 = 91%) and mid-term (MD, 2.65; 95% CI: 1.79, 3.51; I2 = 61%). At the same time, it reduced MNDL short-term (MD, −0.61; 95% CI: −0.91, −0.30; I2 = 92%), but had no significant effect on MNCV. (2) Subgroup analyses showed that ESWT was superior to Control but not significantly better than LCI, especially in SNCV. The excitatory effect of ESWT + PT on the sensory and motor nerves was significantly better than that of PT alone.ConclusionESWT had some excitatory effect on peripheral nerves, especially on sensory nerve studies. Although the efficacy of this treatment was superior to that of the control group, and the combined treatment with PT was more effective than PT alone, its efficacy might not exceed that of LCI.Systematic review registrationUnique identifier: PROSPERO (CRD42024500891).

Objectives: The aim of the study is to evaluate muscles with more prominent needle electromyographic findings to optimize needle electromyography screening of isolated C6 radiculopathy in patients with C6 root lesions. Design: This prospective clinical study was performed on 39 patients with isolated and unilateral cervical radiculopathy selected from all referrals of 1733 patients to the electrodiagnosis unit of the physical medicine and rehabilitation department of a tertiary medical center (from April 2021 to December 2021). The presence of fibrillation potentials, positive sharp waves, and/or neurogenic motor action potentials that occurred in isolation or combination with selected muscles was considered an abnormal finding. Results: Of 1733 referrals, 39 patients (18 males [46.1%] and 21 females [53.8%]), with a mean age of 49.7 ± 9.6 yrs, were found eligible. According to needle electromyography findings, the most involved muscles in C6 root lesion were pronator teres (100%), followed by extensor carpi radialis longus (94.8%), flexor carpi radialis (89.7%), brachioradialis (82%), infraspinatus (82%), supraspinatus (79.4%), deltoid (74.3%), biceps brachii (64.1%), extensor digitorum communis (33.3%), and triceps brachii (15.3%) muscles. Conclusions: The pronator teres is the most involved muscle of patients diagnosed with C6 radiculopathy. It might be considered the key muscle for screening and accurate diagnosis of C6 root involvement. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Electrodiagnostic (EDX) studies play a crucial role in the evaluation of patients with peripheral nervous system disorders. Accurate and succinct communication of test results is critical to patient safety and clinical decision‐making. The objective of this study was to explore EDX reporting preferences of referring physicians to improve quality of communication and patient care. Methods: An online survey was developed, and a purposive sampling strategy was used to recruit physicians in the authors' professional networks. Quantitative and qualitative survey data underwent frequency and thematic analyses, respectively. Results: There were 40 respondents, including: 21 non‐surgical specialists, 12 surgical specialists, and 7 family physicians. Sections rated as most critical were diagnostic impression (97%) and summary/interpretation (72%). Only 18% reported numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without nerve conduction study waveforms. Regarding the format of the data summary and diagnostic impression sections, the majority of respondents preferred bullet points rather than paragraphs. Discussion: The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights important preferences and how they compare to recommended reporting guidelines, which may help improve communication and ultimately patient care. Future efforts should explore larger sample sizes with all key stakeholders in the EDX process to better understand reporting styles and preferences with greater nuance and context. See Editorial on pages 513–515 in this issue. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate if an increased frontal QRST angle (fQRSTa), an electrocardiographic derived index, can predict ventricular arrhythmias in dogs with myxomatous mitral valve disease, as well as to assess its role as a marker of disease progression. One hundred six dogs with myxomatous mitral valve disease and 20 control dogs underwent clinical and echocardiographic examination, along with 3-minute six-lead electrocardiographic recordings. The fQRSTa was calculated for each one of the 126 dogs. Differences between disease stages were investigated, along with possible correlations of the fQRSTa and other electrocardiographic variables associated with increased arrhythmogenesis. Interclass and intraclass correlation tests were applied to investigate repeatability. Finally, the sensitivity and specificity of fQRSTa in identifying arrhythmia predisposition and cardiac remodeling were calculated. An increase related to disease progression was documented for fQRSTa, with significant difference between groups C and B2 from control, and group C from B1. A fQRSTa >126.5 was able to discriminate B1 and control from B2 and C dogs with a sensitivity of over 79% and specificity of 60.66%. A fQRSTa >122.00 also discriminated the presence of arrhythmias from sustained sinus rhythms with a sensitivity of 88.24% and specificity of 70.00%. Finally, the index showed excellent repeatability, and positive correlations with previously reported ECG markers of arrhythmogenesis in dogs with myxomatous mitral valve disease. In conclusion, the fQRSTa is positively corelated to arrhythmogenesis and cardiac remodeling in dogs with myxomatous mitral valve disease. Dogs stages B2 and C show increased fQRSTa, which allows to infer that repolarization is affected as disease progresses. [ABSTRACT FROM AUTHOR]

Surface electromyography (sEMG) is a technique for measuring and analyzing the electrical signals of muscle activity using electrodes placed on the skin's surface. The aim of this paper was to outline the history of the development and use of surface electromyography in dentistry, to show where research and technical solutions relating to surface electromyography currently lie, and to make recommendations for further research. sEMG is a diagnostic technique that has found significant application in dentistry. The historical section discusses the evolution of sEMG methods and equipment, highlighting how technological advances have influenced the accuracy and applicability of this method in dentistry. The need for standardization of musculoskeletal testing methodology is highlighted and the needed increased technical capabilities of sEMG equipment and the ability to specify parameters (e.g., sampling rates, bandwidth). A higher sampling rate (the recommended may be 2000 Hz or higher in masticatory muscles) allows more accurate recording of changes in the signal, which is essential for accurate analysis of muscle function. Bandwidth is one of the key parameters in sEMG research. Bandwidth determines the range of frequencies effectively recorded by the sEMG system (the recommended frequency limits are usually between 20 Hz and 500 Hz in masticatory muscles). In addition, the increased technical capabilities of sEMG equipment and the ability to specify electromyographic parameters demonstrate the need for a detailed description of selected parameters in the methodological section. This is necessary to maintain the reproducibility of sEMG testing. More high-quality clinical trials are needed in the future. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain‐Barré syndrome (GBS) in Istanbul. Methods: Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti‐ganglioside antibodies were analyzed. Results: One hundred seventy‐seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019–February 2020) and 108 during the pandemic (March 2020–March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti‐ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. Interpretation: Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis. [ABSTRACT FROM AUTHOR]

The purpose of this strategic staffing study was to retrospectively evaluate the impact of the charge neurodiagnostic technologist (NDT) within a 24/7 pediatric NAEC Level IV, ABRET LAB-LTM accredited epilepsy monitoring unit (EMU) during a 4-month pilot. The association between a high-reliability organization (HRO), Lean thinking, and organizational strategic goals were utilized as guiding principles. This paper reviews the operational need to further develop frontline neurodiagnostic leadership roles within Ann & Robert H. Lurie Children's Hospital of Chicago along with the design and implementation, training, and competencies required. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Self‐assessment examinations (SAEs) help trainees assess their progress in education. SAEs also provide feedback to training programs as to how factors in training influence examination performance. This study's goal was to examine the relationship between the number of months of training in electrodiagnostic (EDx) medicine, the number of EDx studies during training, and scores on the American Association of Neuromuscular and Electrodiagnostic Medicine SAE. Methods: This was a retrospective study of the 2023 AANEM‐SAE results. In addition to the examination score, participants were asked approximately how many EDx studies they performed in training and how many months of training they had completed. Analysis included correlation of the examination scores with months of training as well as number of EDx studies. In addition, a multivariate linear regression model was developed. Results: A total of 756 participants completed the proctored examination in May 2023. Examination score was moderately and positively correlated with the number of months of training (Pearson r =.5; p <.001) as well as the number of EDx studies during training (Pearson r =.55; p <.001). Scores steadily improved with additional months of training, but leveled off after 300–400 EDx studies. Regression analysis indicated that higher numbers of EDx studies were correlated with a higher examination score even after accounting for the number of months of study. Discussion: We believe that a greater number of months of training is associated with better performance on the AANEM‐SAE and that greatest improvement in examination performance occurs during the first 300–400 EDx studies. [ABSTRACT FROM AUTHOR]

Electrodiagnosis for cervical radiculopathy often involves exploration of the cervical paraspinal muscles. Accurate and reproducible results require a technique with specific anatomic localization, direction of insertion, extent of insertion, scoring system for insertion, and criteria for determining abnormality. We sought to understand if a published technique met these criteria. A Medline search found 39 articles with original research and 10 review articles involving the cervical paraspinals. A library search found 19 textbooks since 2000, but 9 were not available. Only two studies were specific to the question. Neither had reproducible techniques and they contradicted each other. Studies in which the paraspinals were used for comparison or inclusion did not provide any specific technique. The review articles and textbooks typically met none of our criteria and the few that discussed technique at all provided no reproducible methods. Despite 80 years of electrodiagnostic testing, there is no useful, reproducible technique for exploring the cervical paraspinal muscles. Yet such a paraspinal mapping technique has proven invaluable in the lumbar region. For cervical electromyography to be of value, the next step is to understand the anatomy and propose a reproducible technique. Subsequent research will determine whether the neck muscles are helpful in the diagnosis of cervical radiculopathy. The absence of a valid reproducible cervical paraspinal technique impedes clinical and scientific understanding of cervical radiculopathy. [ABSTRACT FROM AUTHOR]

Objective To examine the prognostic value of electroneuronography (ENoG) in predicting functional recovery in severe cases of acute facial palsy. Methods Patients with severe degrees of facial palsy (initial House–Brackmann [HB] grades IV to VI) with available electrodiagnostic studies conducted 2–4 weeks after symptom onset were reviewed retrospectively. The patients were categorized into “good recovery” and “poor recovery” groups, with the former showing mild to no dysfunction (HB I to III) and the latter exhibiting moderate to severe dysfunction (HB IV to VI) on follow-up evaluation, 2 months after onset. ENoG amplitudes in four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris), as well as age, sex, affected side, disease etiology, comorbidities, and laboratory findings, were compared between the two groups. Results Thirty-seven patients were included. Twenty-nine of the patients showed “good recovery,” and eight showed “poor recovery” at 2 months after symptom onset. Univariate analysis yielded no significant difference in age, sex, affected side, disease etiology, comorbidities, and laboratory findings between the two groups. Preserved ENoG amplitudes (individual, average, and trimmed means) were significantly higher in the good recovery group than in the poor recovery group (p

Objective: The diagnosis of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is based mainly on motor nerve conduction studies (NCSs), which may lead to inconclusive results, especially early in the course of the disease. The present study aimed to evaluate sensory NCSs as an additional tool to aid the identification of this illness. Materials and Methods: We retrospectively evaluated the sensory and motor nerve conduction findings of patients with AIDP and compared them with laboratory controls. The sensitivity and specificity of the NCS parameters and sural sparing pattern (SSP) were also assessed. The NCS patterns were categorized as normal, abnormal, and no response. The association of sensory nerve action potential (SNAP) amplitude patterns and effect of the timing of the electrodiagnostic examination on sensory and motor NCS patterns were analyzed. Results: The most sensitive sensory nerve conduction findings were reduced ulnar (79.3%) and median (75.9%) SNAP amplitudes, which were more sensitive than the compound muscle action potential amplitudes and forearm motor nerve conduction velocities of these nerves. Employing ulnar SNAP for SSP identification was more useful than using the median SNAP. The timing of the electrodiagnostic studies did not affect the patterns of the sensory nerve conduction parameters. Conclusion: The reduction in the median and ulnar SNAP amplitudes along with SSP, with the ulnar SNAP amplitude used for comparison, is beneficial for diagnosing AIDP regardless of the timing of the electrodiagnostic examination.

A young man from Pakistan had his first-ever tonic-clonic seizure while playing cricket. Since age 12 years, he had reported involuntary jerks and tremulousness, sometimes with falls, particularly with bright lights. Family history included a brother who developed seizures with myoclonus in his mid-20s and parental consanguinity. Developmental history was normal. Examination identified cognitive impairment with action myoclonus. His clinical presentation raised suspicion of a progressive myoclonus epilepsy. MR scan of the brain showed white matter changes suggesting leucodystrophy with cortical atrophy. Electroencephalogram showed generalised epileptiform abnormalities with photoparoxysmal responses, including at low frequencies (1 Hz). Cortical hyperexcitability was confirmed with giant median somatosensory evoked potentials and long loop reflexes at rest. Multichannel electromyography showed action myoclonus with variable synchronous and asynchronous agonist and antagonist muscle activation with short-burst duration of 25-75 ms, and jerk-locked back-averaging showed premyoclonic potentials consistent with cortical myoclonus. Genetic sequencing identified a homozygous missense variant in the CLN6 gene (c.768C>G p. (Asp256Glu), confirming Kufs disease type A. [ABSTRACT FROM AUTHOR]

Nasal Septal Deviation (NSD) is a common sign in otorhinolaryngology that can lead to facial asymmetry. In this case–control observational study, we assessed the role of EMG and NCS in the diagnosis of NSD and its effect on neuromuscular function. Participants were divided into two groups based on paranasal sinus computed tomography scan (PNS CT) results: NSD cases (n = 21) and controls without NSD (n = 13). EMG and NCS were performed on both groups to assess nasal alar muscles at the root of the zygomatic nerve. Our findings showed a significant correlation between NSD and EMG/NCS tests (P-value = 000) and a significant association between septal deviation and nasal alar lateralization (P-value = 000). EMG/NCS can be useful in assessing NSD by providing a better understanding of related neuromuscular structures and neuromuscular function of the nasal alar dilator muscles and aid in the diagnosis of NSD. Nasal Septal Deviation, EMG (electromyography), NCS (nerve conduction studies), Neuromuscular function, Facial asymmetry, Otorhinolaryngology, Paranasal sinus, Computed tomography, Nasal alar muscles, Zygomatic nerve, Nasal Obstruction, Nasal alar lateralization, Diagnosis. [ABSTRACT FROM AUTHOR]

The clinical manifestation of median nerve entrapment at the carpal tunnel level is known as carpal tunnel syndrome (CTS). Electroneurography (ENG) is considered the gold standard in CTS evaluation. We conducted a retrospective study and analyzed some clinical and demographic variables, relating them to the degree of neuropathy using ENG, to better understand the role of ENG in this very common disease. We studied 816 patients referred to our service for neurographic evaluation. Their symptoms were classified as compatible with CTS (cCTS) (n = 646) and atypical for CTS (aCTS) (n = 170). A blind ENG was performed on 797 patients. Patient characteristics were coded as variables and analyzed to study whether they could predict neuropathy severity (sensory and motor involvement or grade ≥ 3 in our classification). We found a correlation between typical symptomatology, age over 50 years, male gender, positivity of Phalen's maneuver and Tinel's sign, and a neuropathy grade ≥ 3. We also found a correlation with CTS in the contralateral hand if the other hand showed neuropathy, despite the lack of symptoms in this hand. We propose a practical algorithm for ENG referral based on clinical symptoms, demographic factors, and neurophysiological variables. [ABSTRACT FROM AUTHOR]