AANEM Monograph: NEE

Question 1

Information provided by NEE

Answer 1

confirm dx. exclude mimics, identify unrecognized, localize, severity, pathophysiology, prognosticate

Question 2

NEE technique

Answer 2

pull skin, insert needle (resting), withdraw to sub q then antigravity with insertion ID units morphology (duration/polyphasia/duraiton) recruitment (occ to interference pattern)

Question 3

When should you quantitate

Answer 3

for mild/early processes

Question 4

Coagulopathy avoid

Answer 4

diaphragm, TA, iliopsoas,fpl, pull skin avoid <30k plat

Question 5

6 firing patterns

Answer 5

regular (<1% variation) - regular no change - regular with exponential change - irregular - semi rhythm (10% variation) - bursts

Question 6

Origins: single fiber firing alone

Answer 6

endplate, fibs ( spike/psw), myotonic)

Question 7

Origins: single fiber firing in groups

Answer 7

insertional - CRDS

Question 8

Origin: Motor unit - individual spont

Answer 8

fasciculation - neuromyotonic - myoclonus - dystronia - stiffman

Question 9

Origin: Motor unit - bursts spont

Answer 9

myokmic - synkinesis - termor - hemifacial spasm

Question 10

Origin: voluntary

Answer 10

motor unit potentials

Question 11

6 factors affecting Motor unit morphology morphology and synchrony

Answer 11

Reinnervation - collateral sprouting - loss of fibers - fiber splitting - atrophy - fiber regeneration

Question 12

Recruitment frequency in limb and cranial

Answer 12

limb - 7-10 hz

cranial 16hz

Question 13

Poor activation reasons

Answer 13

UMN, Pain, cooperation, strong muscle, two joint muscles (gastroc)

Question 14

Goal rise time

Question 15

When looking at 1-4 MUAPs note the

Answer 15

rise time < .6ms - duration (5-15ms) - polyphasia <5 - amplitude <20 - 200 microv - stability(MMAV)

Question 16

increased insertional activity

Answer 16

> 200ms, seen in denervation and mytonic disorders

Question 17

fibrillation potentials reflect

Answer 17

muscle fiber diameter

Question 18

Main categories associated with fibrillation potentials

Answer 18

LMN - NMJ - Myopathies - muscle trauma

Question 19

disease associated with myotonic potentials

Answer 19

myopathy with or without clinical myotnia and neurogenic disorders

Question 20

CRDS usually indicated

Answer 20

chronic neurogenic, myopathic, normal in iliopsoas and biceps

Question 21

ALS: fascics without fibs =

Answer 21

not sufficient for dx

Question 22

situations associated with fascics

Answer 22

hyperthyroid, mestinon , normal in BFS, cramp fasciculation syndrome, neurogenic

Question 23

neurotonic discharge

Answer 23

interoperative nerve irritation

Question 24

2 situations for synkinesis

Answer 24

bell’s - arm-diaphragm

Question 25

First change in a neurogenic lesion

Answer 25

reduced recruitment

Question 26

4 situations that cause long duration MUAPs

Answer 26

increased fiber density, fiber number, loss of synchrony, collateral sprouting, reinnervation

Question 27

diseases causing long duration MUAPs

Answer 27

chronic neurogenic, myopathies

Question 28

diseases causing short duration

Answer 28

myopathy - nmj - early reinnervation or late stage atrophy - periodic paralysis

Question 29

diseases causing unstable MUAPs

Answer 29

NMJ, neurogenic (reinnervation/progressive) - inflammatory myopathies

Question 30

MUAPS in tremor fire in ___.

Answer 30

groups

Question 31

Patterns: Normal recruitment with short duration polyphasic MUAPs

Answer 31

with variation - severe NMJs occ primary myopathies - | without variation - primary myopathies

Question 32

Patterns: normal recruitment and normal muaps

Answer 32

normal and some metabolic myopathies

Question 33

Patterns: reduced mixed durations

Answer 33

chronic myopathies - no variation in acute neurogenic but subacute there can be

Question 34

Patterns: Reduced short duration polyphasic

Answer 34

without variation severe myopathy, end stage neurogenic disorder with variation early/ongoing reinnervation

Question 35

Patterns: Reduced long duration polyphasic

Answer 35

chronic neurogenic or if variation then ongoing neurogenic lesion

Question 36

Patterns: Reduced mixed durations

Answer 36

rapid neurogenic lesion

Question 37

Patterns: Rapid recruitment

Answer 37

instability except for mild myopathies - long duration in chronic myopathies short duration in all other myopthies.