Professional Documents
Culture Documents
AND EVOKED
POTENTIALS
CORRY MAHAMA
DIVISI NEUROFISIOLOGI
BAGIAN/KSM NEUROLOGI
ELECTROMYOGRAPHY (EMG)
•
•
•
• Performing a thorough clinical evaluation
• Conducting the needle exam:
• Preparing the pt
• Selecting appropriate muscles to test
• Inserting and moving the needle electrode
• Collecting the data
• Recognizing special situations related to the ability to examine
muscles
• Analyzing the recorded activity
• Recordings are made with a disposable concentric needle
electrode inserted into the muscle.
• A fine wire in the axis of the needle is insulated from the shaft,
the end of the needle being cut at an acute angle.
• The area of the recording surface determines the volume of
muscle that the needle can ‘‘see’’. Conventional EMG needles
record from a hemisphere of radius of about 1 mm.
• Within this volume there are some 100 muscle fibres. The many
hundreds of muscle fibres belonging to one motor unit are
distributed widely throughout the cross section of the muscle
and, therefore, within the pick-up region of the needle there may
be just 4–6 fibres of a single motor unit.
• Analysis of the waveforms and firing rates of single motor or
multiple motor units can give diagnostic information.
• Fibrillation,
• Fasciculation
• Myotonia
• Myokimia
Analyzing the motor unit
• Ask pt to minimally contract the muscle
• Sweep speed: 10 msec/div; gain 200-500 mV/div
• Components of the Motor Unit:
1. amplitude,
2. rise time,
3. duration
4. phases.
Recruitment
• orderly addition of motor
units so as to increase
the force of a
contraction.
• A contraction becomes
stronger in two ways:
the firing motor units
increase their rate of
firing and additional
motor units commence
firing.
Somatosensory Evoked Potentials (SSEP)
• Pre- & post- synaptic responses
• to assess for lesions or disorders in the CNS, and they are usually
abnormal in patients with lesions involving the auditory portion of
CN VIII, the auditory pathways in the brain stem, or both
• may be performed in awake and cooperative patients or those with
an altered mental status
• are usually performed with a click stimulus that is delivered
monaurally and that activates the peripheral and central auditory
pathways.
• Auditory stimuli cause sequential activity in CN VIII, the cochlear
nucleus, the superior olivary nucleus, the lateral lemniscus, and the
inferior colliculus.
• GENERATORS
• It is not known whether BAEPs are generated by nuclei, tracts, or a
combination of the two. The following waves are routinely measured during
BAEP testing:
• I the distal action potential of CN VIII and appears as a negative
potential at the ipsilateral ear electrode. If wave I is absent, central
auditory conduction cannot be assessed reliably.
• II may be generated by either the ipsilateral proximal CN VIII or the
cochlear nucleus.
• III is likely related to activation of the
ipsilateral superior olivary nucleus.
• IV is produced by activation of the
nucleus or axons of the lateral
lemniscus.
• V appears to result from activation
of the inferior colliculus.
• VI and VII are presumed to be
generated by the medial geniculate
body and the thalamocortical
pathways, respectively.
Methods
• BAEPs are performed by stimulating the auditory nerve,
typically with square wave clicks and recording the
evoked response from the scalp.
• Every BAEP study should begin with an assessment of
peripheral auditory function and a bedside test of auditory
acuity should be conducted to determine the hearing
threshold.
• After assessing peripheral auditory acuity, the BAEP study
is performed.
• The time required to perform BAEPs depends on several
clinical factors, but the study usually can be completed in
30–45 minutes.
• BAEPs are evoked with electrical square wave clicks.
• Stimulus intensity should be 65–70dB above the click
hearing threshold for optimal waveform recognition.
Monaural stimulation with contralateral masking noise
provides optimal recognition of unilateral auditory pathway
lesions.
• Failure to identify wave I can be improved with techniques
such as changing stimulus intensity, changing click
polarity from rarefaction to condensation clicks, slowing
the stimulus rate, using tiptrodes, or decreasing muscle
artifact.
• The contralateral ear channel recording may help in
identification of wave II and in distinguishing wave IV from
wave V.
FACTORS AFFECTING THE BAEP
RESPONSE
• BAEP latencies are longer in infants under the age of 2 and in
adults over 60, and are longer in men than women.
• Peripheral hearing loss may cause absence of wave I, delayed
absolute latencies of all waveforms, or distorted or absent
waveforms beyond wave I.
• Stimulus rates greater than 10Hz may increase the BAEP
latencies and decrease amplitudes.
• Stimulus intensities less than 65–70dB above hearing
threshold may increase absolute and interpeak latencies,
decrease amplitude, and alter waveform morphology.
• Changing polarity of the click may affect the amplitude and
morphology of wave I.
INTERPRETATION OF BAEPs
• Pupillary size
• Age, gender
• Patient cooperation
Ab(n)
interocular an optic nerve lesion on the side of increased value
difference in
P100 latency
(both P100
values (N)
Bilateral Bilateral optic nerve lesions
increased
P100 latency Chiasmatic lesion