Clinical

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Clinical

  1. 1. Reflex & ConductionReflex & Conduction Liu, An-Bang M.D., M.M.Sci.Liu, An-Bang M.D., M.M.Sci. Department of Neurology, Tzu Chi Medical Center, Hualien, TaiwanDepartment of Neurology, Tzu Chi Medical Center, Hualien, Taiwan Division of Neuromuscular Research and Neurogenetics,Division of Neuromuscular Research and Neurogenetics, Tzu Chi Neuro-Medical Scientific Center, Hualien, TaiwanTzu Chi Neuro-Medical Scientific Center, Hualien, Taiwan The Clinical Application of NeuroscienceThe Clinical Application of Neuroscience
  2. 2. The Problem of Neurology Is Montreal Neurological Institute & Hospital to Understand Human Himself Wilder Penfield
  3. 3. Principles of Electrophysiologic StudyPrinciples of Electrophysiologic Study
  4. 4. Instruments & IntroductionInstruments & Introduction ElectrodeElectrode AnodeAnode CathodeCathode AmplitudeAmplitude FrequencyFrequency CalibrationCalibration FilterFilter
  5. 5. General DevicesGeneral Devices
  6. 6. ElectrodesElectrodes
  7. 7. StimulatorStimulator
  8. 8. Nerve Conduction StudyNerve Conduction Study
  9. 9. Compound Motor Action PotentialCompound Motor Action Potential latency duration amplitude amplitude
  10. 10. Nerve Conduction StudyNerve Conduction Study
  11. 11. Nerve Action PotentialsNerve Action Potentials
  12. 12. Sensory Action PotentialsSensory Action Potentials
  13. 13. Structures of Peripheral NerveStructures of Peripheral Nerve
  14. 14. Nerve ConductionNerve Conduction
  15. 15. Temporal DispersionTemporal Dispersion
  16. 16. F-WavesF-Waves
  17. 17. Tested NervesTested Nerves Median nerveMedian nerve  CMAPs and SAPsCMAPs and SAPs Ulnar nerveUlnar nerve  CMAPs and SAPsCMAPs and SAPs Tibial nerveTibial nerve  CMAPs, H-reflexCMAPs, H-reflex Peroneal nervePeroneal nerve  CMAPsCMAPs Sural nerveSural nerve  SAPsSAPs
  18. 18. Median NerveMedian Nerve
  19. 19. Median NerveMedian Nerve
  20. 20. Nerve Conduction VelocityNerve Conduction Velocity NCV=NCV=∆∆distance/distance/∆∆latencylatency 45-55 m/Sec45-55 m/Sec
  21. 21. Ulnar NerveUlnar Nerve
  22. 22. Ulnar NerveUlnar Nerve
  23. 23. Radial NerveRadial Nerve
  24. 24. Radial Nerve (SAP)Radial Nerve (SAP)
  25. 25. Peroneal NervePeroneal Nerve
  26. 26. Peroneal NervePeroneal Nerve
  27. 27. Tibial NerveTibial Nerve
  28. 28. Tibial NerveTibial Nerve
  29. 29. Sural Nerve (SAP)Sural Nerve (SAP)
  30. 30. H-reflexH-reflex
  31. 31. H-ReflexH-Reflex The H-reflex can normally be seen in many muscles but is easily obtained in the soleus muscle (with posterior tibial nerve stimulation at the popliteal fossa), the flexor carpi radialis muscle (with median nerve stimulation at the elbow), and the quadriceps (with femoral nerve stimulation).
  32. 32. H-ReflexH-Reflex The H-reflex can normally be seen in many muscles but is easily obtained in the soleus muscle (with posterior tibial nerve stimulation at the popliteal fossa), the flexor carpi radialis muscle (with median nerve stimulation at the elbow), and the quadriceps (with femoral nerve stimulation).
  33. 33. ApplicationsApplications To confirm the diagnosis of neuropathyTo confirm the diagnosis of neuropathy To evaluate the possible pathologicalTo evaluate the possible pathological changes of neuropathychanges of neuropathy To detect and evaluate the site ofTo detect and evaluate the site of conduction block of entrapment neuropathyconduction block of entrapment neuropathy To insure the diagnosis of multi-focalTo insure the diagnosis of multi-focal conduction block motor neuropathyconduction block motor neuropathy
  34. 34. ContraindicationsContraindications
  35. 35. Facial NerveFacial Nerve Recording sites: Place the active recording over the orbicularis oris at the corner of the mouth, over the orbicularis oculi on the outer canthus of the eye, over the frontalis in the forehead, or over the nasalis muscle on the nasolabial fold. Place the reference electrode on the nose. Either a needle or surface electrode may be used for recording.
  36. 36. Blink ReflexBlink Reflex
  37. 37. Blink ReflexBlink Reflex
  38. 38. Blink ReflexBlink Reflex
  39. 39. ApplicationsApplications To evaluate brainstem dysfunctionTo evaluate brainstem dysfunction
  40. 40. ElectromyographyElectromyography
  41. 41. EMG-NeedlesEMG-Needles
  42. 42. Spontaneous DischargesSpontaneous Discharges
  43. 43. Normal Motor Unit PotentialsNormal Motor Unit Potentials
  44. 44. Motor Unit PotentialsMotor Unit Potentials
  45. 45. RecruitmentRecruitment
  46. 46. Acute Denervational ChangesAcute Denervational Changes fibrillation positive sharp waves
  47. 47. Positive Sharp WavesPositive Sharp Waves
  48. 48. Polyphasic WavesPolyphasic Waves
  49. 49. Giant WavesGiant Waves
  50. 50. Myopathic DischargesMyopathic Discharges Short-duration small-amplitude polyphasic waves
  51. 51. Polyphasic WavesPolyphasic Waves
  52. 52. Positive Sharp Waves
  53. 53. Positive Sharp Waves
  54. 54. MyotomesMyotomes
  55. 55. Anterior TibialisAnterior Tibialis
  56. 56. GastrocnemiusGastrocnemius
  57. 57. Abductor Pollicis BrevisAbductor Pollicis Brevis
  58. 58. First Dorsal InterosseusFirst Dorsal Interosseus
  59. 59. Paraspinalis (lower lumbar)Paraspinalis (lower lumbar)
  60. 60. ApplicationsApplications To localize and stage the lesion ofTo localize and stage the lesion of neuropathy or radiculopathyneuropathy or radiculopathy To differentiate neuropathy from myopathyTo differentiate neuropathy from myopathy To identify neuromuscular junctionTo identify neuromuscular junction disordersdisorders To confirm the diagnosis of motor neuronTo confirm the diagnosis of motor neuron diseasedisease
  61. 61. Motor Evoked PotentialsMotor Evoked Potentials
  62. 62. Brainstem AuditoryBrainstem Auditory Evoked PotentialEvoked Potential
  63. 63. Somatosensory Evoked PotentialsSomatosensory Evoked Potentials

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