Curriculum Vitae

PLACE AND DATE OF BIRTH

Bogor, March 5th 1973

EDUCATION
Neurology, Diponegoro University, Semarang, 2010
Magister of Biomedical Science, Diponegoro University,
Semarang, 2010
M.D. Faculty of Medicine, Christian University of Indonesia,
Jakarta, 2002

TRAINING
Fellowship Advanced Electromyography, RSCM Jakarta,
Jan – Jun 2015
Intra Operative Neurophysiology Monitoring, Jakarta
Workshop Evoked Potential, Jakarta
Workshop Neurophysiology, Denpasar Bali

Dr Andi Avianto Tampubolon,

Tampubolon, M.Si
M.Si.. Med., SpS
PERIPHERAL NERVE DISORDERS

DIAGNOSIS APPROACH ON EMG

Peripheral Nerve Disorder (PND)
Clinical Features
• Motor Nerve Damage
Muscle weakness (flaccid), muscle atrophy, fasciculations,
decreased reflexes
• Sensory Nerve Damage
Pain (hyperalgesia, allodynia), anesthesia/hypesthesia, paresthesia,
loss of position sense
• Autonomic Damage
Retension uri/alvi, incontinence uri/alvi, hyper/anhydrosis,
orthostatic hypotension
• Motor Neuropathies
• Polyneuropathies
• Neuromuscular Transmission Disorder
• Myopathies
• Local Nerve Lesions
• Radiculopathies
• Disorders Of The Spinal Chord And Central Nervous System
With Neuromuscular Abnormalities
Electromyography
• A diagnostic procedure to assess the health of muscles and
the nerve cells that control them (motor neurons).
• Measures muscle response or electrical activity in response to
a nerve’s stimulation of the muscle.
• Surface EMG and Needle EMG
• Small Risk
• Etiology
– 5-10% hereditary
– Degeneration of both upper and lower motor neuron
• Clinical Features
– Incidence 2/100.000
– Painless weakness
– Upper Limb > Lower Limb
– UMN Signs
• Diagnostic Criteria
– The diagnosis of ALS requires the presence of:
(1) lower motor neuron signs (LMS), (2) upper
motor neuron signs (UMS) and (3) progression of
the disorder
– 1. definite ALS: LMS in three regions and UMS
– 2. probable ALS: LMS in two regions and UMS
– 3. possible ALS: LMS in one region and UMS
– 4. suspected ALS: LMS in two or three regions
• EMG findings
– Subacute neurogenic in at least 3 regions
– No definite proximal or distal predominance
– Reduced MCS amplitude (often)
• Management
– Disease-modifying treatment : Riluzole 50mg
twice daily
– Symptom-based management : Respiratory
management, dysphagia and nutrition, symptom
management (dysarthria, dyspnea, muscle
spasm, pain, psychosocial, sleep problem)
• Etiology
– 1-2% paralysis
– Attenuated virus paralysis : 1 / million
• Clinical Features
– Paralytic Disorder
– Risk of paralysis : Adult 10 times than chidren
– Post-polio sydrome
• EMG findings
– Acute neurogenic EMG
– Reduced amplitude in weak muscles
• Management
– Symptom-based management
– Physical Therpy
• Etiology
– No well defined biological parameters
• Clinical Features
– Post-polio syndrome after 15 years stable
period
– Distribution of weakness varies
• EMG findings
– Inactive neurogenic involvement
– MCS may showed reduced amplitudes
• Management
– Symptom-based management
– Physical Therpy
• Etiology
– Autoimmune preceding infection (especially
Campylobacter jejuni)
• Clinical Features
– Incidence 1-2/100.000 per year. Male >
female
– 80 % paresthesia, 60 % weakness, weakness
in legs before arms (ascending)
– Worsen 2-4 weeks, plateau 6-12 months
– Mortality 2-5 %
• EMG findings
– Conduction block, distal latency prolonged
– Reduce MCV
– Low amplitude
• Management
– Plasmapharesis
– IVIG
• Etiology
– Prolonged autoimmune
• Clinical Features
– Chronic progressive course or relapsing
– Progression > 6 weeks
– Bilateral symmetric weakness
– Elevated CSF protein
• EMG Findings
– Reduced MCV, conduction block,
– Reduced SCV
• Management
– Plasmapheresis
– IVIG
• Etiology
– Autoimmune against acetylcholine receptors
• Clinical Features
– Incidence 2-10/1000000 per year
– Female > male
– Abnormal fatigability amd weakness
– Muscle innervated cranial nerve and proximal
muscle > distal muscle
– Ptosis
• EMG findings
– Repetitive stimulation decreament
• Management
– Anticholinesterase
– Plasmapheresis
– IVIG
– Glucocorticoids
– Thymectomy
• Etiology
– Autoimmune against muscle fibers
• Clinical Features
– Incidence 1-9/1000000 per year
– Female > male
– Proximal limb and neck flexor muscles
– CK moderately elevated
• EMG findings
– Fibrilations
– Small brief MUPs
– Later long duration polyphasic
• Management
– Glucocorticoids
– Azathioprine
– Methotrexate
• Etiology
– Autosomal dominant inheritance
• Clinical Features
– Attacks are precipitated by carbohydrate
ingestion or strenuous exercise
– During attacks serum potassium is decreased
• EMG findings
– MCS reduced M wave amplitude
– Insertionalactivity is reduced
– Reduced ineterference pattern
– Reduction in duration and amplitude of MUPs
• Management
– Potassium suplementation
• Etiology
– Chronic compression of the median nerve in
the carpal tunnel
• Clinical Features
– Paresthesias digit 1-3
– Atrophy thenar muscle
• EMG findings
– Median nerve reduce amplitude, prolonged
distal latency
– Reduced SCS amplitude
– Reduced
• Management
– Physiotherapy
– Steroid injection
– Surgery
• Etiology
– Entrapment in the canal Guyon
– Chronic compression to the hypotenar region
• Clinical Features
– Paresthesia and loss of sensation fingers 4-5
– Weakness of ulnar innervated muscle
• EMG findings
– Chronic compression of the median nerve in
the carpal tunnel

• Management
– Steroid Injection
– Physiotherapy
• Etiology
– Plexus Brachial Injury
• Clinical Features
– Muscle weakness and sensory abnormalities
– Muscle atrophy
• EMG findings
– MCS and SCS amplitude reduced
– Neurogenic activity in needle EMG
– Spontaneus activity
• Management
– Physical Exercise
– Surgery
• Etiology
– Herniated Disc
– Fracture,spondyloartrosis
– Tumour
• Clinical Features
– Pain and radiating pain
– Cervical : Brachialgia, sensory disturbance,
muscle weakness
– Lumbal : Ischilgia, sensory disturbance,
muscle weakness
• EMG findings
– Needle EMG neurogenic activity, polyphasic,
long duration, high amplitude
– NCS may be normal
• Managemet
– Physical exercise
– Surgery
• Etiology
– Development, vascular and traumatic disease
• Clinical Features
– Sensory loss of pain and temperature,
preservation of touch
– Muscle weakness andatrophy
• EMG findings
– MCS and AMPL may be reduced
• Management
– Surgery
• Etiology
– Probably autoimmune against glutamic acid
decarboxylase (GAD)
• Clinical Features
– Tightness and aching of axial muscle
– Symmetric stiffness
– Painfull muscle spasm
– Tendon reflexes normal or increased
– Reduced with sleep, benzodiazepine and
anesthesia
• EMG findings
– Abundant EMG activity
• Management
– Diazepam
– Glucocorticoid
– IVIG