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Clinical practice guidelines for intraoperative neurophysiological monitoring: 2020 update
Korean Society of Intraoperative Neurophysiological Monitoring,Korean Neurological Association,Korean Academy of Rehabilitation Medicine,Korean Society of Clinical Neurophysiology,Korean Association o 대한임상신경생리학회 2021 Annals of Clinical Neurophysiology Vol.23 No.1
The utility and accuracy of intraoperative neurophysiological monitoring (IONM) has evolved greatly following the recent development of new devices for neurophysiological testing and advances in anesthesiology. Until recently, the need for IONM services has been limited to large academic hospitals, but the demand for neurophysiologists with expertise in IONM has grown rapidly across diverse types of hospital. The primary goal of the Korean Society of Intraoperative Neurophysiological Monitoring (KSION) is to promote the development of IONM research groups and to contribute to the improvement of fellowship among members and human health through academic projects. These guidelines are based on extensive literature reviews, recruitment of expert opinions, and consensus among KSION board members. This version of the guidelines was fully approved by the KSION, Korean Association of EMG Electrodiagnostic Medicine, the Korean Society of Clinical Neurophysiology, the Korean Academy of Rehabilitation Medicine, and the Korean Neurological Association.
Nerve conduction studies: basic principal and clinical usefulness
Ahn, Suk-Won,Yoon, Byung-Nam,Kim, Jee-Eun,Seok, Jin Myoung,Kim, Kwang-Kuk,Lim, Young Min,Kwon, Ki-Han,Park, Kee Duk,Suh, Bum Chun,Korean Society of Clinical Neurophysiology Education Committee The Korean Society for Clinical Neurophysiology 2018 Annals of Clinical Neurophysiology Vol.20 No.2
Nerve conduction study (NCS) is an electrophysiological tool to assess the overall function of cranial and peripheral nervous system, therefore NCS has been diagnostically helpful in the identification and characterization of disorders involving nerve roots, peripheral nerves, muscle and neuromuscular junction, and are frequently accompanied by a needle Electromyography. Furthermore, NCS could provide valuable quantitative and qualitative results into neuromuscular function. Usually, motor, sensory, or mixed nerve studies can be performed with using NCS, stimulating the nerves with the recording electrodes placed over a distal muscle, a cutaneous sensory nerve, or the entire mixed nerve, respectively. And these findings of motor, sensory, and mixed nerve studies often show different and distinct patterns of specific abnormalities indicating the neuromuscular disorders. The purpose of this special article is to review the neurophysiologic usefulness of NCS, to outline the technical factors associated with the performance of NCS, and to demonstrate characteristic NCS changes in the setting of various neuromuscular conditions.
Potential risks of nerve conduction studies and needle electromyography
Yoon, Byung-Nam,Ahn, Suk-Won,Kim, Jee-Eun,Seok, Jin Myoung,Kim, Kwang-Kuk,Kwon, Ki-Han,Park, Kee Duk,Suh, Bum Chun,Lim, Young Min,Korean Society of Clinical Neurophysiology Education Committee The Korean Society for Clinical Neurophysiology 2018 Annals of Clinical Neurophysiology Vol.20 No.2
Electrodiagnostic studies such as nerve conduction studies (NCS) and needle electromyography (EMG) provide important and complementary information for evaluating patients with suspected neuromuscular disorders. NCS and needle EMG are reasonably safe diagnostic investigations and are generally associated with only mild transient discomfort when performed by experienced physicians. However, there is the risk of complications in some patients, because NCS involve the administration of electric current and EMG involves inserting a needle percutaneously into muscle tissue. This article reviews the potential risks of NCS and needle EMG.
Evoked potential: basic requirements and guidelines for writing reports
Lee, Eun-Mi,Seok, Hung Youl,Park, Kee Duk,Seo, Dae-Won,Korean Society of Clinical Neurophysiology Education Committee The Korean Society for Clinical Neurophysiology 2018 Annals of Clinical Neurophysiology Vol.20 No.1
Evoked potentials (EPs) measures the electrophysiologic responses of the nervous system to variety of stimuli. In clinical practice, only a few are used on a routine basis. Because of the small amplitude of EPs recorded by noninvasive methods, computer summation or averaging generally is necessary to resolve them from background noise. Therefore, waveform acquisition under good condition according to standard method is important. We aimed to provide the standards for clinical EP equipment, technical consideration and minimal requirements for obtaining good clinical EP waveforms, and general criteria for writing EP reports in practice as Korean guidelines.
Basic requirements for visual evoked potentials
Seok, Hung Youl,Lee, Eun-Mi,Park, Kee Duk,Seo, Dae-Won,Korean Society of Clinical Neurophysiology Education Committee The Korean Society for Clinical Neurophysiology 2018 Annals of Clinical Neurophysiology Vol.20 No.1
Visual evoked potentials (VEPs) are frequently used to assess the anterior and posterior visual pathways. In particular, the use of VEPs have been increasing in various fields such as evaluation of the optic nerves in patients with multiple sclerosis. The performance of VEP test can be affected by various factors such as stimulus type and subject condition, and its interpretation is also difficult. However, there have been no guidelines for performing and interpreting VEPs in Korea. Therefore, we aimed to provide comprehensive information regarding basic requirement and interpretation for VEPs.
Electroencephalography for the diagnosis of brain death
Lee, Seo-Young,Kim, Won-Joo,Kim, Jae Moon,Kim, Juhan,Park, Soochul,Korean Society of Clinical Neurophysiology Education Committee The Korean Society for Clinical Neurophysiology 2017 Annals of Clinical Neurophysiology Vol.19 No.2
Electroencephalography (EEG) is frequently used to assist the diagnosis of brain death. However, to date there have been no guidelines in terms of EEG criteria for determining brain death in Korea, despite EEG being mandatory. The purpose of this review is to provide an update on the evidence and controversies with regarding to the utilization of EEG for determining brain death and to serve as a cornerstone for the development of future guidelines. To determine brain death, electrocerebral inactivity (ECI) should be demonstrated on EEG at a sensitivity of $2{\mu}V/mm$ using double-distance electrodes spaced 10 centimeters or more apart from each other for at least 30 minutes, with intense somatosensory or audiovisual stimuli. ECI should be also verified by checking the integrity of the system. Additional monitoring is needed if extracerebral potentials cannot be eliminated. Interpreting EEG at high sensitivities, which is required for the diagnosis of brain death, can pose a diagnostic challenge. Furthermore, EEG is affected by physiologic variables and drugs. However, no consensus exists as to the minimal requirements for blood pressure, oxygen saturation, and body temperature during the EEG recording itself, the minimal time for observation after the brain injury or rewarming from hypothermia, and how to determine brain death when the findings of ECI is equivocal. Therefore, there is a strong need to establish detailed guidelines for performing EEG to determine brain death.
Basic concepts of needle electromyography
Kim, Jee-Eun,Seok, Jin Myoung,Ahn, Suk-Won,Yoon, Byung-Nam,Lim, Young-Min,Kim, Kwang-Kuk,Kwon, Ki-Han,Park, Kee Duk,Suh, Bum Chun,Korean Society of Clinical Neurophysiology Education Committee Korean Society of Clinical Neurophysiology 2019 Annals of Clinical Neurophysiology Vol.21 No.1
Clinical evaluations, nerve conduction studies, and electromyography play major complementary roles in electrophysiologic diagnoses. Electromyography can be used to assess pathologic changes and localize lesions occurring in locations ranging from motor units to anterior-horn cells. Successfully performing electromyography requires knowledge of the anatomy, physiology, and pathology of the peripheral nervous system as well as sufficient skill and interpretation ability. Electromyography techniques include acquiring data from visual/auditory signals and performing needle positioning, semiquantitation, and interpretation. Here we introduce the basic concepts of electromyography to guide clinicians in performing electromyography appropriately.
Fundamental requirements for performing electroencephalography
Koo, Dae Lim,Kim, Won-Joo,Lee, Sang-Ahm,Kim, Jae Moon,Kim, Juhan,Park, Soochul,Korean Society of Clinical Neurophysiology Education Committee The Korean Society for Clinical Neurophysiology 2017 Annals of Clinical Neurophysiology Vol.19 No.2
The performance of electroencephalogram (EEG) recordings is affected by electrode type, electronic parameters such as filtering, amplification, signal conversion, data storage; and environmental conditions. However, no single method has been identified for optimal EEG recording quality in all situations. Therefore, we aimed to provide general principles for EEG electrode selection as well as electronic noise reduction, and to present comprehensive information regarding the acquisition of satisfactory EEG signals. The standards provided in this document may be regarded as Korean guidelines for the clinical recording of EEG data. The equipment, types and nomenclature of electrodes, and the details for EEG recording are discussed.