Practical Guide for Clinical Neurophysiologic Testing: EP, LTM, IOM, PSG, and NCS

302 Pages·20.218 MB·English

by  Yamada T., Meng E.

Practical Guide for Clinical
Neurophysiologic Testing
EP, LTM, IOM, PSG, and NCS
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Practical Guide for Clinical
Neurophysiologic Testing
EP, LTM, IOM, PSG, and NCS
Thoru Yamada, MD, FAASM, FACNS
Professor
Department of Neurology
Chief, Division of Clinical Electrophysiology
University of Iowa Roy J. and Lucille A. Carver College of Medicine
Iowa City, Iowa
Elizabeth Meng, BA, R.EEG/EP T.
EEG Technologist
Department of Neurology
Maryvale Hospital
Phoenix, Arizona
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Library of Congress Cataloging-in-Publication Data
Yamada, Thoru, 1940– author.
Practical guide for clinical neurophysiologic testing : EP, LTM, IOM, PSG, and NCV / Thoru Yamada, MD, Professor,
Department of Neurology, University of Iowa, Iowa City, Iowa, Elizabeth Meng, BA, R.EEG/EP T., Surprise, Arizona.
p. ; cm.
Includes bibliographical references and index.
Summary: “This book provides advanced content that begins where the “Practical Guide for Clinical Neurophysiologic Testing:
EEG” ends. This advanced guide, more geared to neurology fellows than to electroneurodiagnostic technologists, discusses
evoked potentials, including visual, brainstem auditory, and somatosensory EPs. The author covers intraoperative neurophysi-
ologic monitoring, epilepsy monitoring, long-term bedside EEG monitoring, and sleep studies”—Provided by publisher.
ISBN-13: 978-1-60913-714-4 (pbk.)
ISBN-10: 1-60913-714-0 (pbk.)
1. Nervous system-—Diseases. 2. Electroencephalography. 3. Evoked potentials (Electrophysiology) 4. Neurologic
examination. 5. Sleep disorders. I. Meng, Elizabeth, author. II. Title.
[DNLM: 1. Nervous System Diseases-—diagnosis. 2. Electroencephalography—methods. 3. Evoked Potentials. 4. Neurologic
Examination-—methods. 5. Sleep Disorders--diagnosis. WL 141]
RC346.Y36 2011
616.8'047547—dc22
2010051087
Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the
authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information
in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the
publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.
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in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes
in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged
to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This
is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited
use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or
device planned for use in their clinical practice.
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Contributors
Adel K. Afi fi , MD, MS Chike Linton, MD
Professor Emeritus Fellow in Sleep Medicine
Departments of Pediatrics, Neurology, and Anatomy and Cell Department of Neurology
Biology University of Iowa Roy J. and Lucille A. Carver College of Medicine
University of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City, Iowa
Iowa City, Iowa
Elizabeth Meng, BA, R.EEG/EP T.
Mark Eric Dyken, MD, FAHA, FAASM EEG Technologist
Professor of Neurology Department of Neurology
Director, Sleep Disorders Center Maryvale Hospital
University of Iowa Roy J. and Lucille A. Carver College of Medicine Phoenix, Arizona
Iowa City, Iowa
Sheila Mennen, RNCST
Jada Franck, CNIM, R.EEG T. Chief EMG Technologist, EMG laboratory
Clinical Instructor in Health Science Department of Neurology
Kirkwood Community College University of Iowa Health Care
Cedar Rapids, Iowa Iowa City, Iowa
EEG Technologist
University of Iowa Hospitals and Clinics Shekar Raman, MD, FAASM
Iowa City, Iowa Director, Sleep Disorders Center
Department of Neurology
Gloria Galloway, MD, FAAN Hunter-Holmes McGuire Veterans Affairs Medical Center
Professor of Neurology and Pediatrics Richmond, Virginia
Ohio State University
Director, Intraoperative Monitoring Program Leigha Rios, RNCST, R.EEG T.
Nationwide Children’s Hospital Electroneurodiagnostic Technologist
Columbus, Ohio Department of Neurology
University of Iowa Hospitals and Clinics
Christine L. Glenn, RPSGT, R.EEG T. Iowa City, Iowa
Chief Clinical Laboratory Technologist
Department of Neurology Peter Seaba, MS
University of Iowa Senior Engineer, Division of Clinical Neurophysiology
Iowa City, Iowa Department of Neurology
University of Iowa Hospitals and Clinics
Mark A. Granner, MD, FACNS Iowa City, Iowa
Clinical Professor of Neurology
Medical Director, Epilepsy Service Wendy Sebetka, RNCST, R.EEG T.
University of Iowa Roy J. and Lucille A. Carver College of Medicine Electroneurodiagnostic Technologist
Iowa City, Iowa Department of Neurology
University of Iowa Health Care
Kyoung Bin Im, MD Iowa City, Iowa
Associate
Departments of Internal Medicine and Psychiatry Erik K. St. Louis, MD, FAASM, FACNS
University of Iowa Roy J. and Lucille A. Carver College of Medicine Associate Professor of Neurology
Iowa City, Iowa Director, Cognitive Neurophysiology Laboratory
Mayo Clinic College of Medicine
Deborah C. Lin-Dyken, MD, FAAP Rochester, Minnesota
Clinical Associate Professor of Pediatrics
University of Iowa Roy J. and Lucille A. Carver College of Medicine Jon Tippin, MD, FAASM, FAAN, FACNS
Iowa City, Iowa Clinical Associate Professor
Department of Veterans Affairs Medical Center
University of Iowa Roy J. and Lucille A. Carver College of Medicine
Iowa City, Iowa
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vi Contributors
Marjorie Tucker, CNIM, CLTM, R.EEG/EP T., Thoru Yamada, MD, FAASM, FACNS
RNCST Professor
END Program Director Department of Neurology
Kirkwood Community College Chief, Division of Clinical Electrophysiology
Cedar Rapids, Iowa University of Iowa Roy J. and Lucille A. Carver College of Medicine
EEG Laboratory Coordinator Iowa City, Iowa
University of Iowa Hospitals and Clinics
Iowa City, Iowa
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Foreword
Neurophysiologic testing has become increasingly useful in trained under Dr. Yamada and Ms. Meng and their colleagues
several medical specialties, including orthopedic surgery, neu- at Iowa.
rosurgery, cardiology, ophthalmology, and otolaryngology, to Recognition of the historical and current national role of
mention only a few. But no specialty has made greater capital of Iowa neurologists and technologists has come in the form of
measuring and analyzing the electrical properties of an organ their election to important national positions as offi cers of the
system than neurology. The electrophysiology of the brain and American Society for Electrodiagnostic Technologists (ASET)
spinal cord is more complex than the heart, and arguably more (Ms. Margaret Gordon, past president) and selection as mem-
so than the retina or inner ear, so it should come as no surprise bers of the American Board of Registration of Electroenceph-
that neurologists have invested decades of effort to refi ning alographic and Evoked Potential Technologists (ABRET)
techniques that can objectively measure neurological function (Dr. Thoru Yamada and Ms. Elizabeth Meng), and as current
in the neurophysiology laboratory and supplement the clinical president of the ABRET (Ms. Marjorie Tucker). Dr. Yamada
neurological examination. and Ms. Meng also served as members of the Committee on
In this book, Dr. Thoru Yamada, Ms. Elizabeth Meng, and Accreditation of Electroneurodiagnostic Programs (CoA END)
their colleagues reveal what their combined extensive experi- under the auspices of the Commission on Accreditation of
ence has taught them about neurophysiologic testing. There Allied Health Education Program (CAAHEP). As a neurologist
are several general points of emphasis in this book that will and clinical neurophysiologist, Dr. Yamada served as a member
become very apparent to the reader. First, an understanding of of American Board of Clinical Neurophysiology (ABCN), as an
the anatomy of the nervous system region being tested is critical editorial board member of the Journal of Clinical Neurophysiology
to obtaining meaningful clinical information from neurophysi- (offi cial journal of the American Clinical Neurophysiology
ologic testing. Accordingly, an overview of the anatomy is typi- Society) and Clinical Neurophysiology (offi cial journal of the
cally found at the beginning of each chapter in this book. Sec- International Federation of Clinical Neurophysiology), and as a
ond, meticulous technique is required in order to obtain results medical editor for the American Journal of Electroneurodiagnostic
that the clinician can believe in and use to make critical clinical Technology (offi cial journal of the ASET).
decisions. Such meticulous technique depends on a productive The serious student of clinical neurophysiologic testing will
partnership between the physician and the technologist; total fi nd this volume to be more than a “how to” manual and a com-
devotion to excellence in only one of the members of this team pendium of the rationale, technique, and interpretation of tests
will not yield a satisfactory result. This is the credo that has char- that are inherent to the modern practice of neurology. If these
acterized the neurophysiology laboratories at the University of features are not enough to merit our praise of this volume, the
Iowa since their beginning over seven decades ago under the pearls and pit falls of the contributors’ combined decades of
leadership of Dr. John Knott, one of the pioneers in establish- experience are certainly the topping on this wonderful confec-
ing the clinical utility of electroencephalography. These prin- tion of instruction.
ciples have also formed the core of the longstanding and suc-
cessful educational program for END (ElectroNeuroDiagnostic) Robert L. Rodnitzky, MD
technologists at Iowa, one of the oldest continually functioning Professor of Neurology
programs of its type in the nation. It is this same tradition of University of Iowa Carver College of Medicine
excellence that now forms the basis of practice for scores of Iowa City, Iowa
laboratories around the world whose physicians or technologists
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Preface
When we wrote Practical Guide for Clinical Neurophysiologic reference. That being said, we give our sincere thanks to the
Testing: EEG (referred to as “Practical Guide: EEG” in this text chapter authors. Without them, we would not be able to offer
book), our intention was to write a comprehensive, basic text this text. We are also indebted to Deb Stratton, as always, for her
book for the END technologist as well as the neurology resi- administrative skills.
dent. It soon became obvious that such a text would be too This book offers the basic knowledge and technique for the
cumbersome. It also seemed logical to us that the basics of EEG END technologist and, at the same time, challenging chapters
knowledge serve as the basis for knowledge in the other disci- that will help the neurology resident gain insight into the
plines; therefore, we felt that the initial text should be EEG. patient’s condition. It is not intended to be a comprehensive
That, of course, left us with a second textbook that we now review of each specialty. We have included an on-line question
present, Practical Guide for Clinical Neurophysiologic Testing: EP, bank, which is intended to serve as a guide to the reader’s basic
LTM, IOM, PSG, and NCS. With so many subspecialties repre- understanding of the chapter rather than as a preparation for
sented in this text, it served the reader best to offer the writing certifi cation/registration examinations. We hope that it will
of chapters to those who have proven expertise in each area. become a valuable resource for every comprehensive END
The University of Iowa’s Department of Neurology is blessed to laboratory.
have such experts either currently or recently in their employ.
We have drawn from the best to present this textbook as the Thoru Yamada, MD
remainder of our quest for a comprehensive, basic END Elizabeth Meng, BA, R.EEG/EP T.
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Contents
Contributors v
Foreword vii
Preface viii
Section I Evoked Potentials
1 Principles of Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Thoru Yamada, Elizabeth Meng, and Peter Seaba
2 Visual Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Thoru Yamada and Elizabeth Meng
3 Brainstem Auditory Evoked Potentials and Auditory
Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Thoru Yamada and Elizabeth Meng
4 Somatosensory Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Thoru Yamada and Elizabeth Meng
Section II Intraoperative Neurophysiologic Monitoring
5 Introduction and Recording Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Jada Franck and Marjorie Tucker
6 EEG Monitoring for Carotid Endarterectomy . . . . . . . . . . . . . . . . . . . . . . . . 95
Thoru Yamada and Elizabeth Meng
7 Spinal Cord Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Gloria Galloway
Section III Long-Term EEG Monitoring
8 Diagnostic Video-EEG Monitoring for Epilepsy and Spells:
Indications, Application, and Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . 143
Erik K. St. Louis
9 Invasive Video EEG Monitoring in Epilepsy Surgery Candidates:
Indications, Technique, and Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Mark A. Granner
10 Long-Term Bedside EEG Monitoring for Acutely Ill Patients
(LTM/cEEG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Thoru Yamada and Elizabeth Meng
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x Contents
Section IV Sleep Studies
11 Sleep Physiology and Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Mark Eric Dyken, Adel K. Afi fi , and Kyoung Bin Im
12 Technology of Polysomnography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Christine L. Glenn
13 Sleep Apnea and Related Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Chike Linton, Shekar Raman, and Christine L. Glenn
14 Evaluating Narcolepsy and Related Conditions . . . . . . . . . . . . . . . . . . . . . . . 253
Jon Tippin
15 Parasomnias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Mark Eric Dyken and Deborah C. Lin-Dyken
Section V Nerve Conduction Studies
16 Nerve Conduction Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Wendy Sebetka, Sheila Mennen, and Leigha Rios
Index 289
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