Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice

1177 Pages·2013·11.38 MB·English

by  Jun Kimura

Advance Praise for
Electrodiagnosis
in Diseases of Nerve and Muscle,
Fourth Edition
Th e new edition of this classic text will be welcomed not only by trainees in electrodiagnostic medicine but by established physicians
who seek a comprehensive and up-to-date account of the specialty by one of its masters. Jun Kimura—a former editor-in-chief of the
journal Muscle and Neve and a past president of the International Federation of Clinical Neurophysiology—has made seminal personal
contributions to the fi eld and is recognized widely as an authority on electromyography and electrodiagnosis. His experience over
many years as a physician, investigator, and teacher has been distilled to produce this outstanding, comprehensive new edition. Th e
volume, which incorporates the advances of the years, will serve as a terrifi c informational resource as well as facilitating daily practice
for both new and established specialists. It is a mine of information.
Michael J. Aminoff , MD, DSc, FRCP, Distinguished Professor and Executive Vice Chair, Department of Neurology,
University of California, San Francisco, CA
Th is Fourth Edition of Electrodiagnosis in Diseases of Nerve and Muscle by Jun Kimura lives up to all expectations—updating a classic
reference that has been the “go-to” resource for a generation of electromyographers and neuromuscular clinicians the past thirty years.
Major sections have been revised, new material included, outdated references removed, and the text streamlined to emphasis current
concepts and practice. Th e clearly writt en and well-illustrated descriptions of the electrodiagnostic evaluation and expected results in
health and disease are both practical and comprehensive, making the book appropriate for trainees and veteran electromyographers
alike. Th is resource is a worthy companion of every physician who evaluates patients with suspected neuromuscular disorders. It is a
resource to be read and consulted on a regular basis, not one that will collect dust on the owner’s bookshelf.
James W. Albers, MD, PhD, Emeritus Professor of Neurology, University of Michigan Health System, Ann Arbor, Michigan
Th is edition of Kimura is the most complete, authoritative, up-to-date, and readable text on electrodiagnosis available today. It is a
multi-layered resource that will serve not only as a primer for the EMG beginner, but also as a reference text for the experienced elec-
trodiagnostic consultant.
Kerry Levin MD, Chairman, Department of Neurology, Director, Neuromuscular Center Cleveland Clinic
Great News—Jun Kimura’s Electrodiagnosis in Diseases of Nerve and Muscle—Principles and Practice Fourth Edition is out. Even though
several decades have past since this book was fi rst conceived it remains the Gold-Standard in the discipline and no text on the subject
has out-performed this bible. A text-book of this scope today, is rarely writt en by a single authority, but much of the success of the previ-
ous editions have been due to Professor Kimura’s unique ability to cover essentials in ways few others can. His knowledge of the subject
is vast, and as the years have gone by, like a good wine, details and controversies have matured.
A new and welcome feature of the 4th Edition is the creation of a CD. Th is adds important practical value to the book, allowing readers
to watch and listen to various types of normal and abnormal EMG activities. A valuable tool for those preparing for Certifi cation in
EMG.
Some 5000 new references were reviewed in the preparation of the new edition selecting the pertinent and up-to-date information. Th e
4th Edition, describes several new techniques that have emerged since the previous edition, with expanded coverage of topics crucial
to theory and practice of EMG. New to the 4th edition is a section on intra-operative monitoring, studies for the pediatric and geriatric
populations and data analysis and reporting. All of which should help facilitate daily practice.
Kimura’s text remains an essential for all those practicing electromyography. Jun Kimura has expertise in Neurology, Physiology and
Engineering and all Neurologists, Neurosurgeons, Phsyiatrists, Orthopedic and Hand Surgeons and medical students, even if not run-
ning an EMG laboratory will do well to read this book. Without it their medical education is lacking and limited.
Andrew Eisen MD., FRCPC, Professor Emeritus Neurology, University of British Columbia, Vancouver, BC, Canada
Th e pleasant surprise as I reviewed this fourth edition was the substantial amount of change in organization of sections and chapters,
in addition to updates of the material. Age-related information, both pediatric/development and geriatric/aging are now co-located.
Similarly late responses now follow the nerve conduction chapters, rather than being lumped into Special Techniques with pediat-
rics. Th roughout this manuscript, Jun Kimura has updated his elegantly writt en textbook, and it is still the most readable in the fi eld.
Whether your interest is the secrets of volume conduction or the basics of median nerve testing, this book belongs on your desk. As a
bonus, the consistent chapter structure and thorough indexing makes easy work of fi nding specifi c details of interest.
William S. Pease, MD, Ernest W. Johnson Professor, Physical Medicine and Rehabilitation,
Th e Ohio State University Wexner Medical Center , Dodd Hall Rehabilitation Hospital, Columbus, OH
ELECTRODIAGNOSIS

IN DISEASES OF
NERVE AND MUSCLE
Principles and Practice

FOURTH EDITION
JUN KIMURA , MD
PROFESSOR EMERITUS
DEPARTMENT OF NEUROLOGY
KYOTO UNIVERSITY
KYOTO, JAPAN
and
PROFESSOR
DIVISION OF CLINICAL ELECTROPHYSIOLOGY
DEPARTMENT OF NEUROLOGY
UNIVERSITY OF IOWA COLLEGE OF MEDICINE
IOWA CITY, IA, USA
1
3
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You must not circulate this work in any other form
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Library of Congress Cataloging-in-Publication Data
Kimura, Jun.
Electrodiagnosis in diseases of nerve and muscle : principles and practice/Jun Kimura.—4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–19–973868–7 (hardcover)
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]
616.7′407547—dc23
2012019483

Th e science of medicine is a rapidly changing fi eld. As new research and clinical experience broaden our knowledge, changes in
treatment and drug therapy occur. Th e author and publisher of this work have checked with sources believed to be reliable in their
eff orts to provide information that is accurate and complete, and in accordance with the standards accepted at the time of publication.
However, in light of the possibility of human error or changes in the practice of medicine, neither the author, nor the publisher, nor
any other party who has been involved in the preparation or publication of this work warrants that the information contained herein
is in every respect accurate or complete. Readers are encouraged to confi rm the information contained herein with other reliable
sources, and are strongly advised to check the product information sheet provided by the pharmaceutical company for each drug they
plan to administer.
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
To Leslie Miya
As requested by my wife, Junko, for the courage and grace shown by the youngest
of our fi ve granddaughters in a heroic batt le with leukemia,
which we hope she will overcome.
This page intentionally left blank
Preface and
Acknowledgments
PREPARA TION FOR this revision began in 2001 I take heart in the belief that justice, though blind-
soon aft er the completion of the third edition folded, will eventually prevail and truth always
delivered in haste during an uninvited encoun- sets you free.
ter with the law. To consolidate the voluminous Although the basic premises remain in elec-
text, the goal intended but unmet at that time, I trophysiologic problem solving, advanced tech-
have now deleted old or impractical concepts nology has brought considerable modifi cations
and removed outdated references not directly in the way we practice this discipline. A num-
related to current practice. I have then updated ber of new techniques emerged necessitating an
the contents based on some 5000 new articles expanded coverage of the areas considered crucial
selected for information pertinent to the day-to- in theory or practice as they relate to electrodiag-
day clinical studies, which turned into a slow and nostic medicine. I have also added brief chapters
tedious process. Fortunately, I had suffi cient time on intraoperative monitoring, studies for the
to streamline the manuscript for the sake of brev- pediatric and geriatric populations, and data anal-
ity, especially with the completion of my tenure ysis and reporting, which should help facilitate
for the World Federation of Neurology and aft er daily practice. New for this edition, the book now
the end of the malicious prosecution, which I had comes with a DVD for waveform reproduction,
to endure for some time as mentioned in the pref- which we successfully tried in the production of
ace of the last edition. Incredible as it may sound, a Japanese counterpart of this volume published
a totally unforeseen turn of events involving the last year. I wish to thank Dr. Nobuo Kohara, a
corrupt public offi ce surfaced in 2004, leading to a friend of mine in Kyoto, who created the tape and
confession, which fi nally substantiated our claim. Mr. Hitoshi Sano of Nihon Kohden, Inc., who
• vii
modifi ed it for the use in this edition. I wish also on electronics, updating the references, and Pete
to acknowledge Igakushoin, Inc. for allowing me Seaba, MSEE, gave helpful advice. I am indebted
to reproduce some of the waveforms used in their to our Chief Technologist, Sheila Mennen, who
publication. typed time and time again the voluminous man-
I have rewritt en, in their entirety, the chapters uscripts not only for this but also for all previ-
on principles of nerve conduction studies; the ous editions dating back some 30 years. Leigha
F wave and A wave; other techniques to assess Rios assembled all new references and fi led
nerve function; facts, fallacies, and fancies of them in order, and, last but not least, Wendy
nerve stimulation technique; somatosensory and Sebetka proofed every page of the manuscript, in
motor evoked potentials; and all of the clinical between their busy schedule as electrodiagnostic
sections. Th e remaining chapters also underwent technologists.
a complete overhaul not only to refl ect current Aft er returning to Iowa, I kept close contact
understanding based on careful review of new with former colleagues in Kyoto who special-
papers but also to delete some old, now discarded ize in clinical electrophysiology : Drs. Hiroshi
techniques. I have reduced the coverage of special Shibasaki, Ryuji Kaji, Nobuo Kohara, Takashi
procedures no longer routinely conducted such Nagamine, Hiroyuki Nodera, and Takahiro
as provocative studies of neuromuscular trans- Mezaki among others, jointly contributed many
mission. Although I omitt ed most old articles new research insights useful for this revision.
unless they describe a classic contribution, an I owe special thanks to Ichiro Akiguchi for his
ample inclusion of new references should enable support during my transition from Kyoto to Iowa.
interested readers to consult the original sources. Machiko Miyamoto, with her daughter Maya,
Th e use of common abbreviations as listed in the kept the Uji offi ce in order for processing neces-
title page of each chapter should help improve the sary literature as the only assistant profi cient in
readability while, at the same time, consolidat- English, and Kayoko Morii took care of my sec-
ing sentences. I have tabulated normative data retarial needs in Japan. I wish to thank Mr. Craig
used in our laboratory in Appendix 1 at the end Panner at Oxford University Press, who encour-
of the book together with myotomes useful for aged me to initiate this revision and Susan Lee,
needle studies and height – minimum, mean, and Karen Kwak and Leslie Anglin, who guided me
maximum F-wave latency nomograms to allow with patience and perseverance. I acknowledge
quick access to the reference values during busy the American Association of Neuromuscular
practice. and Electrodiagnostic Medicine (AANEM)
Th roughout the preparation of this revision, and its Nomenclature Committ ee, who granted
I had the good fortune to work in the Division of permission to reprint the AAEM Glossary of
Clinical Neurophysiology, directed by Dr. Th oru Terms in Electrodiagnostic Medicine (2001) as
Yamada, and the Department of Neurology, Appendix 4.
headed by Dr. Robert L. Rodnitzky, who, together In concluding, I wish to update my account
with Drs. Torage Shivapour, Jon Tippin, and Eric on our household, which in the earlier editions
Dyken, encouraged my venture ever since the triggered many kind commentaries. We now
publication of the fi rst edition in 1983. Dr. George have an empty nest as our three sons have left
Richerson, who joined the department as the new home to build their own. Th e third generation
chair in 2010, supported my endeavor, allowing comprises three boys and fi ve girls residing in
me to work at my own pace so that I may devote San Francisco, Madison, and Iowa City, where
myself to writing. I enjoyed a most fl exible time we also have our home. Junko, my wife, periodi-
schedule thanks to Dr. Edward Aul, the director cally visits all fi ve posts, including my frequent
of the EMG Laboratory, Dr. Andrea Swenson, retreat in Kyoto, for various household chores
who ran the neuromuscular clinic, and Drs. Jim and babysitt ing, thus her self-imposed nick-
Worrell, Joe Chen, and Heather Bingham, who name, “international cleaning lady.” Th e book,
fi lled in regularly to help with the clinical work. dedicated to Leslie on her behalf, att ests to
David Walker, MSEE, provided the Appendix 2 our appreciation for her skills in aff ectionately
viii • Preface and Acknowledgments
maintaining law and order not only at home but to pursue another project for a while. But on this
also abroad for the growing family. I endorse her sunny winter day, when we wrap up the current
conviction that we must endow the royalties of endeavor, the future can wait.
the book to our grandchildren, who represent
our new hopes and fresh aspirations. Having Jun Kimura, MD
exhausted all my resources, I will fi nd it diffi cult Iowa City, IA
Preface and Acknowledgments • ix