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Electromyography and neuromuscular disorders clinical and electrophysiologic correlations. By David C. Preston and Barbara C

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skillfully handles the still thorny issue of correlation of implied M R imaging-defined pathology and clinical disability,
without overstepping the boundaries of current knowledge.
The final chapter, with Donald W. Paty, is a useful review of
the role of M R in modern clinical trials, drawing on the
considerable experience and insight of the contributors.
Whereas the literature of this burgeoning field may still be
encompassed by its active participants, most will benefit
from this assessment of the current state of the art. This reviewer flagged quite a number of pages for future reference.
Updated editions of this book can be expected. They would
benefit from publication of the figures on a higher grade paper and replacement of the earlier, lower resolution images
that otherwise nicely complement the text.
jerry S. Wolinsky, MD
Houston, T X
Electromyography and Neuromuscular Disorders,
Clinical and Electrophysiologic Correlations
By David C. Preston and Barbara C. Shapiro
Boston, Butterworth-Heinemann, 1998
581 pp, illustrated
The authors have written this book for physicians who perform and interpret nerve conduction studies and electromyography in patients with neuromuscular disorders. The text is
designed to integrate electrodiagnosis in the evaluation and
treatment of patients with neuromuscular disease. It is organized into two main parts. The first sections deal with nerve
conduction studies, electromyography, and clinical-electrophysiologic correlation. The second part deals with diseases
including mononeuropathy, polyneuropathy, motor neuron
disease, radiculopathy, and disorders of neuromuscular transmission and muscle. The authors, who direct neuromuscular
units, emphasize that these studies extend the neuromuscular
examination, and therefore, the interpretation reflects the
clinical ability of the examiner. This stresses the point that
physicians, who perform these electrodiagnostic studies, must
be trained also in neurology and neuromuscular disease. Emphasis is placed on the specific studies performed in each
patient to establish a diagnosis and answer the clinical questions. Because the studies rely o n technical equipment and
methods, it is also essential that the person performing these
studies be well trained and versed in the use and upkeep of
the electrophysiologic equipment.
430
Annals of Neurology
Vol 44
No 3
September 1998
The book is well illustrated and there are excellent photographs of humans with placement of the electrodes both
for nerve conduction studies and electromyography. It is unfortunate that, with the modern technology available, the authors still measure nerve action potentials to peek as well as
onset. Early studies, without the use of modern electronic
averagers, had to measure to peek because of the difficulty
with determining the onset of the potential. With current
equipment, averaged nerve action potential onset should be
visible, allowing accurate measurement to onset. The authors
describe common artifacts of the techniques and stress the
importance of recording in a warm laboratory with the patient's temperature at 33" to 34°C to avoid cooling artifact.
The chapters dealing with the localization of lesions in peripheral nerves, plexus, and roots are excellent and make the
text valuable to all clinicians involved in the evaluation of
these patients. Each of the chapters has excellent descriptions, diagrams, tables, and case reports with specific electromyographic data. There are excellent discussions of the clinical, anatomical, and physiologic correlations. The chapters
dealing with muscle disease are not as well presented as those
dealing with focal nerve lesions.
The book would be improved if there was further discussion of single-fiber electromyography and its value in the
evaluation of patients with neurogenic and myopathic disorders as well as those with disorders of neuromuscular transmission. The appendix would be improved if it included
data, from the world literature, of normal values of nerve
conduction and motor unit parameters in children and
adults of different ages. Normal data, with means and standard deviations, would be of more value than means with
greater or less than symbols. The book would be more authoritative if there were more references, including the original reports of normal and abnormal data.
Overall, the book is well written and illustrated, and it
fulfills the objectives of the authors to integrate electrodiagnosis with the clinical evaluation of patients with neuromuscular disorders. Physicians with the appropriate training and
background will enjoy reading this text and using it to help
them in their electrophysiologic studies of patients.
Richard F. Mayer, MD
Baltimore, M D
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correlation, preston, clinical, electromyography, disorder, electrophysiologic, david, neuromuscular, barbara
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