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Biopsy Processing Protocol
Published in Maher Kurdi, Neuromuscular Pathology Made Easy, 2021
Muscle biopsy is the initial step of the diagnostic process in a patient with a neuromuscular condition. Accurate selection of the biopsied muscle will help the pathologist to detect and conclude the morphological findings. This is based on a detailed clinical history, physical examination, and investigations of the symptomatic patient. Electrodiagnostic studies through electromyography (EMG) or nerve conduction tests (NCTs) are always helpful in the differential diagnosis as well as the histological assessment.
Neurology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Fenella Kirkham, Adnan Manzur, Stephanie Robb
Electrodiagnostic studies: Stimulation single fibre electromyography.Repetitive nerve stimulation (often poorly tolerated in young children and may be falsely negative; it is occasionally performed under general anaesthesia if there is diagnostic difficulty).
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Electrodiagnostic testing – EMG and NCS. Others include skin conductivity, quantitative sensory testing, quantitative sudomotor axon reflex test (QSART), laser Doppler flow and response to sympathetic block.
Myasthenic crisis as an initial presentation of myasthenia gravis in an 81-year-old following endoscopic myotomy for Zenker’s diverticulum
Published in Baylor University Medical Center Proceedings, 2023
Daniel Tran, Lucas Fair, Bryana Baginski, Bola Aladegbami, Steven Leeds, Marc Ward
Physical examination may reveal muscle weakness, ptosis, or impaired extraocular movements. However, physical examination may reveal normal muscle strength due to a fluctuating disease pattern. In these cases, repeated muscle use can demonstrate weakness. In a patient with suspected MG, serum testing for AChR antibodies is the first recommended step in diagnosis.7 Multiple other diagnostic tests can be performed. Electrodiagnostic techniques, such as nerve conduction studies and routine needle electromyography, can be performed to exclude alternative diagnoses or to confirm a concomitant disorder.7 Pharmacologic testing with edrophonium can be used, but is associated with serious adverse reactions.8 The ice pack test is a quick and simple bedside method that can be used. If there is improvement in ptosis after ice is placed on a closed lid for 2 minutes, it is a positive test result.9
Effect of omalizumab treatment on peripheral nerves in patients with chronic spontaneous urticaria
Published in Cutaneous and Ocular Toxicology, 2021
Erman Altunisik, Esra Inan Dogan
We found only one study in the literature examining the effect of omalizumab treatment on peripheral nerves. In that study, the nerve conduction examinations of patients receiving omalizumab treatment were compared between the pre-treatment period and at three months after treatment. Although there was no pathological finding indicating neuropathic involvement as a result of this comparison, significant changes such as prolonged latencies, reduced amplitudes, and slowed conduction velocity were observed in some nerves after treatment compared to the pre-treatment values, and thus the authors concluded that treatment could affect peripheral nerves8. We used a similar method in our study but evaluated a higher number of motor and sensory peripheral nerves. Similar to the previous research, we detected no pathological finding indicating peripheral nerve involvement in the measured values and there was no significant change in the latency, amplitude and conduction velocity values of the peripheral nerves before and after treatment. Electrodiagnostic measurements can be affected by many factors. These include age, ethnicity, gender, physical conditions of the electrophysiology laboratory, extremity temperature measured, patient height and weight, and the difference in standard values among electrophysiology laboratories21. These factors may have contributed to the emergence of different results despite the use of similar methods with the aforementioned study. Our results led us to consider that omalizumab treatment is not a therapeutic agent that causes pathological effects on peripheral nerves.
The clinical spectrum of primary lateral sclerosis
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2020
Richard J. Barohn, John K. Fink, Terry Heiman-Patterson, Edward D. Huey, Jennifer Murphy, Jeffrey M. Statland, Martin R. Turner, Lauren Elman
Evaluation for motor neuron disease includes imaging and additional testing to exclude other causes for the syndrome. Electrodiagnostic studies remain an integral part of the assessment. A normal EMG that includes muscles from the bulbar, cervical, thoracic, and lumbosacral segments should bring the diagnosis of ALS into question, although early in the disease, the EMG can be benign. It should be noted, though, that up to 45% of PLS patients followed over time had mild electrodiagnostic changes of denervation (4). Central nervous system motor conduction studies that demonstrate cortical inexcitability rather than hyperexcitability by transcranial magnetic stimulation would support a diagnosis of ALS rather than PLS, although these studies are not part of the usual clinical evaluation.