Protocol Number: 05-N-0223

Title:

Clinical Neurophysiology: Training and Normative Values

Number:

05-N-0223

Summary:

This training protocol has two objectives: 1) to train NINDS fellows in specialized techniques for diagnosing neurological disorders, and 2) to gather data from healthy volunteers and from patients with various disorders needed for tests to diagnose disorders of nerve, muscle, and the areas of the brain controlling movement.

Healthy volunteers and patients with neurological disorders of nerve and muscle who require specialized diagnostic testing may be eligible for this study. Candidates must be 21 years of age or older. They are screened with a medical history and neurological examination.

Immediately after screening, participants undergo one or two of the following tests:

-Transcranial magnetic stimulation: This procedure maps brain function. A wire coil is held on the scalp, and a brief electrical current is passed through the coil, creating a magnetic pulse that stimulates the brain. During the stimulation, the subject may be asked to tense certain muscles slightly or perform other simple actions. The stimulation may cause a twitch in muscles of the face, arm, or leg, and the subject may hear a click and feel a pulling sensation on the skin under the coil. During the stimulation, electrical activity of muscles is recorded with a computer, using electrodes (small metal disks) attached to the skin with tape.

-Electromyography (EMG): This test measures the electrical activity of muscles and is used to diagnose problems with the nerves or muscles. For surface EMG, electrodes are filed with a conductive gel and taped to the skin. Needle EMG involves inserting a needle into a muscle to record the electrical activity. Single fiber EMG uses specialized needles that allow recording from single muscle fibers. The needle is inserted into a muscle and the subject is asked to tense that muscle slightly.

-Nerve conduction study: This test measures the speed with which nerves conduct electrical impulses and the strength of the connection between the nerve and the muscle. It is done by taping wires on the skin to record the impulses and placing a probe on the skin to deliver a small electrical stimulus.

-Near-nerve recording: This test is a nerve conduction study that is used to measure responses from very small nerves. It uses a needle placed under the skin to record the nerve response.

-Quantitative sensory testing: This test measures how well the subject feels vibration and cold. A probe that can vibrate or cool down is attached to the subject's finger or foot. The subject presses a button when he or she feels the stimulus. A computer adjusts the intensity of the stimulus to find the lowest level the subject can feel.

-Nerve ultrasound: This test uses sound waves to examine the nerves. Warm gel is applied to the skin and a probe is held on the skin surface.

Sponsoring Institute:

National Institute of Neurological Disorders and Stroke (NINDS)

Recruitment Detail

Type: Participants currently recruited/enrolled

Gender: Male & Female

Referral Letter Required: Yes

Population Exclusion(s): Children

Eligibility Criteria:

INCLUSION CRITERIA:

Patients

-Adult patients with a clinical indication for the diagnostic procedures will be enrolled.

-Suspected disorders of neuromuscular transmission, such as myasthenia gravis or

-Suspected Central demyelinating disorders such as multiple sclerosis or

-Suspected Myelopathy or

-Suspected motor neuron disease or

-Suspected Movement disorders that impair intracortical processes

or

-Suspected neuropathy or myopathy

Healthy volunteers

-Healthy adults, aged 21- or older, willing to participate

EXCLUSION CRITERIA:

Patients

-Patients with implanted devices, such as pacemakers, or metal in the cranium (excluding dental work) will be excluded from magnetic stimulation studies.

-Children under age 21 will be excluded, since the goal of this protocol is to provide training experience.

-Subjects who are unable to provide informed consent

Healthy Volunteers

-Medical conditions that require medications that affect the physiological measures being tested

-History of stroke, peripheral neuropathy or spine surgery

-Implanted devices or metal in the cranium (except dental work) if undergoing magnetic stimulation

Special Instructions:

Currently Not Provided

Keywords:

Magnetic Stimulation

Single Fiber EMG

Ultrasonography

Quantitative Sensory Testing

Near-nerve recording

Recruitment Keyword(s):

Neurological Disorders

Neuromuscular Transmission Disorders

Central Demyelinating Disorders

Myelopathy

Motor Neuron Disease

Movement Disorders

Healthy Volunteer

Condition(s):

Nervous System Diseases

Investigational Drug(s):

None

Investigational Device(s):

None

Intervention(s):

None

Supporting Site:

National Institute of Neurological Disorders and Stroke

Contact(s):

Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citation(s):

Sanders DB, Stalberg EV. AAEM minimonograph #25: single-fiber electromyography. Muscle Nerve. 1996 Sep;19(9):1069-83. Review.

Daube JR. Electrodiagnostic studies in amyotrophic lateral sclerosis and other motor neuron disorders. Muscle Nerve. 2000 Oct;23(10):1488-502. Review.

Sandberg A, Hansson B, Stalberg E. Comparison between concentric needle EMG and macro EMG in patients with a history of polio. Clin Neurophysiol. 1999 Nov;110(11):1900-8.

• Questions about participating in a study, please contact the Patient Recruitment and Public Liaison Office, CC.
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