Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice 3rd Edition

1024 Pages·2001·11.12 MB·English

by  Jun Kimura M.D.

ELECTRODIAGNOSIS
IN DISEASES
OF NERVE AND MUSCLE
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ELECTRODIAGNOSIS
IN DISEASES
OF NERVE AND MUSCLE
Principles and Practice
Edition 3
JUN KIMURA, M.D.
Professor Emeritus
Department of Neurology
Kyoto University
Kyoto, Japan
Professor
Division of Clinical Electrophysiology
Department of Neurology
University of Iowa College of Medicine
Iowa City, Iowa
OXFORD
UNIVERSITY PRESS
2001
OXFORD
UNIVERSITY PRESS
Oxford New York
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Copyright © 2001 by Oxford University Press, Inc.
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Kimura, Jun.
Electrodiagnosis in diseases of nerve and muscle: principles and practice / Jun
Kimura.—Ed. 3.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-19-512977-6 (cloth : alk. paper)
1. Neuromuscular diseases—Diagnosis. 2. Electromyography. 3. Electrodiagnosis.
I. Title.
[DNLM: 1. Neuromuscular Diseases—diagnosis. 2. Electrodiagnosis—methods. 3.
Neural Conduction—physiology. 4. Spinal Cord Diseases—diagnosis. 5. Synaptic
Transmission—physiology. WE 550 K49e 2000]
RC925.7 .K55 2000
616.7'407547—dc21 00-025011
As new scientific information becomes available through basic and clinical research,
recommended procedures undergo changes. The author and publisher have done
everything possible to make this book accurate, up-to-date, and in accord with
accepted standards at the time of publication. Nonetheless, the reader is advised
always to check changes and new information regarding the current practice and
contraindications before conducting any tests. Caution is especially urged with new
or infrequently used equipment.
1 3 5 7 9 8 6 42
Printed in the United States of America
on acid-free paper
To Junko
and
our growing family
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PREFACE AND
ACKNOWLEDGMENTS
I know it is unwise to open introductory remarks with excuses be-
cause they instantaneously weaken the impact and preempt the
thrust of the message. Nonetheless, I wish to offer an explanation
for the enormous delay of this publication in spite of my good in-
tention to comply with the warm encouragement for a timely revi-
sion.
In 1989, immediately after the completion of the second edition,
unforeseen turns of events prompted my unscheduled return to
Kyoto to teach at my alma mater. I was able to maintain close ties
with the University of Iowa thanks to Dr. Antonio Damasio, Chair
of the Department of Neurology, who offered me a joint appoint-
ment with a ten-year leave of absence. Despite this liaison, an un-
planned relocation at once doomed any hopes of repeating a six
year cycle of revisions from the original date of publication in 1983.
Besides, continued involvement with the Muscle & Nerve, as well
as the International Federation of Clinical Neurophysiology (IFCN)
and the World Federation of Neurology (WFN), in essence, precluded
any progress toward a timely finish.
Additionally, I found myself in the midst of a re-entry crisis after
a 30 year stay abroad which climaxed with a sadly misdirected le-
gal probe into our accounting of research donation from pharma-
ceutical industry and the fund raising for the 10th International
Congress of EMG and Clinical Neurophysiology (X-ICEMGCN Ky-
oto, 1995). Ironically, the incident provided me with an unexpected
opportunity to concentrate on rewriting the manuscripts as pro-
longed and persistent press surveillance all but forced my unin-
tended seclusion at home. In fact, I found myself in an ideal posi-
tion to update the text using ample and uninterrupted time with
which to analyze bits and pieces of documents assembled over the
past several years. The turmoil, which was widely publicized in
Japan as one of the biggest scandals of 1997, ended triumphantly
(for us) with the resignation of the prosecutor in charge and the
disbandment of the special task force, proving yet again that jus-
tice may be blindfolded but the truth always sets you free.
vii
During this interim, some new fields have emerged in our disci-
pline requiring their inclusion as additional chapters and other ex-
isting areas have gained importance in patient care necessitating
expanded coverages. These include magnetic stimulation, human
reflexes, late responses, motor unit number estimate, quantitative
electromyography, and threshold electrotonus to mention only a
few. Advanced technology has brought considerable modifications
in theory and practice in many other areas, although the basic
premises remain the same in electrophysiologic approaches and in
clinical problem solving. Parallel advances in other fields of neuro-
science have led to equally exciting progress in the exploration of
many disease processes in general, and to the understanding of
neuropathies, muscular dystrophies, myasthenic syndrome and
movement disorders in particular. I have thus rewritten, in their
entirety, the chapters on principles and variation of conduction
studies; facts, fallacies and fancies of nerve stimulation technique;
other techniques to assess nerve function; the F wave and A wave;
somatosensory and motor evoked potentials; electrodiagnosis in the
pediatric population; and all the clinical sections included in Part
VI and Part VII with the addition of ethical consideration in clini-
cal practice as an appendix. The remaining chapters also under-
went substantial changes to reflect current understanding. The ad-
dition of some 2500 new papers, which I personally reviewed, attest
to the incredible advances in what was once considered to be a sta-
tic, rather than dynamic, field of clinical electrophysiology. To
achieve comprehensive coverage, I retained most of the old articles
to document earlier contributions. However, for the sake of brevity,
the text emphasizes basic principles, summarizing only pertinent
points for day to day practice. The inclusion of ample new refer-
ences should enable interested readers to consult the original pa-
pers for further details.
My decision to take on this venture affected—directly or indi-
rectly—many innocent bystanders who had to shoulder additional
workloads while I devoted myself in writing. In particular, I owe spe-
cial thanks to our staff in Kyoto guided by Dr. Ichiro Akiguchi who,
along with Dr. Shinichi Nakamura, Dr. Nobuyuki Oka and Dr. Shun
Shimohama, assumed many administrative chores. Dr. Ryuji Kaji,
together with Dr. Nobuo Kohara, supervised the Clinical Neuro-
physiology Laboratory where our post-doctoral fellows contributed
many new research insights useful for this revision. I am most grate-
ful to Professor Hiroshi Shibasaki and his staff, which consisted of
Dr. Hidenao Fukuyama, Dr. Takashi Nagamine and Dr. Akio Ikeda
of the Department of Clinical Brain Pathophysiology for their sup-
port. Our secretarial personnel, including Mari Yamane, Kayoko
Morii, Kyoko Maekawa, Tomoko Noboru and Kumiko Imai,
processed an enormous amount of English literature without hav-
ing prior exposure to foreign materials. Last, but not least, Machiko
Miyamoto typed and retyped the entire volume single-handedly, as
she was the only Japanese assistant proficient in English.
It was my good fortune to be able to complete the revision at the
Division of Clinical Neurophysiology at the University of Iowa headed
by Dr. Thoru Yamada, who directs the EEG section there with the
assistance of Drs. Malcom Yeh and Dr. Mark Granner. I enjoyed a
most flexible time schedule in the EMG section thanks to Dr. Ed-
ward Aul who filled in whenever necessary, along with the help of
viii
Dr. Torage Shivapour and Dr. Jon Tippin. Dr. Eric Dyken, in charge
of the Sleep Disorder Laboratory, read the entire book and provided
useful suggestions. David Walker, M.S.E.E., rewrote the appendix
on electronics, which was previously co-authored by Pete Seaba,
M.S.E.E., who also gave helpful advice. I am indebted to Sheila Men-
nen, Shelli Hahn and Leigha Rios for their indispensable technical
and clerical help during my renewed part-time work in Iowa. Ms.
Mermen had already assisted with the first and second editions,
therefore, I appreciated her sentiment when she inquired as to
whether there would ever be a fourth edition!
I would also like to thank Lauren Enck and Susan Hannan at
Oxford University Press for inheriting the 3rd edition from F.A. Davis
in the midst of production, and for guiding me with patience and
encouragement despite the slow progress of the adopted project. I
am indebted to the American Association of Electrodiagnostic Med-
icine (AAEM) and its Nomenclature Committee, who granted me per-
mission to reprint the AAEE Glossary of Terms in Clinical Elec-
tromyography (1987) as Appendix 5.
In concluding this acknowledgment, I wish to update a personal
note on our household which, in the earlier editions, triggered many
kind remarks. We now have an attorney in San Francisco, a resi-
dent physician in Madison, and a counselor for handicapped chil-
dren in our home base in Iowa City. Junko, my wife, often refers
to herself as "an international cleaning lady", and periodically vis-
its all five posts including my retreat in Kyoto, which is buried un-
der manuscripts and always ranks bottom in her assessment. Our
boys have finally grown old enough to appreciate the magnitude of
the work involved in producing a textbook. For my 60th birthday,
which in Japan customarily warrants a special celebration in recog-
nition of one's accomplishment (regardless of any achieved), our
three sons and a daughter-in-law came to Kyoto to honor my en-
deavors. I consider it my good fortune to be able to work on this
edition in such a warm and conducive environment.
This book is again dedicated to Junko in appreciation for her com-
panionship, and to our growing family to acknowledge their com-
passionate, albeit spiritual, support. I take great comfort in the
thought that, at long last, we may endow the royalty from this book
as down payment for their first homes rather than tuition: I am
thrilled that, for a change, we can actually witness the rewards of
our investment!
Kyoto, Japan J. K.
ix