Guidelines for Electrodiagnostic Medicine Consultations

2. Guidelines forElectrodiagnostic MedicineConsultations By S. Khosrawi MD Physiatrist

3. EDX consultation evaluates nerve and muscle function and is a direct extension of the clinical history and neuromuscular examination

4. EDX studies are a supplement to, not a replacement for, a careful history and physical examination by the referring physician and by the EDX physician as part of the EDX consultation

5. EDX consultation provides helpful information to evaluate the integrity and function of motor, sensory and autonomic neurons, nerve roots, brachial and lumbar plexi, peripheral nerves, neuromuscular junction, and muscles And sometimes CNS

6. Main purposes: Is there any lower motor neuron lesions , or not ? If yes ,Where ?

7. numbness, paresthesia dysautonomia fatigability weakness atrophy pain

8. EDX studies are not helpful when pain results from disease or injury that does not effect nerve or neuromuscular function EDX studies are also generally less helpful when weakness or sensory loss is due to central nervous system disease

9. Second diagnosis Inconclusive diagnosis Rapidly evolving disease Course of the disease Unexpected course Change in course Recovery from injury Clinical situations where appropriate medical management requires repeat testing

10. Second diagnosis Inconclusive diagnosis Rapidly evolving disease Course of the disease Unexpected course Change in course Recovery from injury Clinical situations where appropriate medical management requires repeat testing Acceptable tests per 12-month period: Two for CTS,radiculopathy,PNP,myopathy,& NMJ disorders Threefor motor neuronopathy , plexopathy & trauma But repeat EDX testing is NOT necessary in 80% of all cases

11. Instrumentation

12. Neuropathic Process NCS Axonal Demyelinating Latency NCV Amplitude

13. Radiculopathy or Plexopathy H-reflex Late responces F-wave

14. EMG

18. THE END