神経生理2 advanced：神経筋電気診断のstrategy

抄録

Advanced clinical neurophysiology, or electrodiganosis, is not a research using novel examinations. This means a competence that can diagnose patients with neuromuscular symptoms based on clinical history and neurological findings, and thorough understanding of neuromuscular anatomy, as well as knowledge on individual neurophysiological tests. Neurological diagnosis should be established on neurological symptomatology, which in turn should be supported by neuromuscular electrodiagnosis. Lack of either symptomatology or electrodiagnosis is insufficient. Diagnosis based on imaging, skipping symptomatology and electrodiagnosis, will incur frequent misdiagnosis. History and neurological examinations are by far more critical as diagnostic tools in neurology than subspecialties of internal medicine. This is because the consciousness is in the center of the nervous system, which is the territory of neurology. When something happens within the nervous system, the consciousness can feel and explain what happens, which is the “history” and would help us to localize the lesion. Furthermore, the examiner can give stimulations to the body, evaluate the power of individual muscles, communicate with the patient using language, and thus can further narrow the lesion site : these are neurological examinations. The situation is quite different from disorders of internal medicine, such as diabetes or malignancy. Electrodiagnosis is closely linked with symptomatology because the nervous system conveys the information using electricity. Thus, electrodiagnosis may document direct counterpart of the weakness or sensory loss, and may accurately localize the lesion site along the nervous pathway. Among neurological findings, manual muscle testing (MMT) is especially useful for the neuromuscular electrodiagnosis. MMT is useful for the differentiation between amyotrophic lateral sclerosis and cervical spondylosis, especially cervical spondylotic amyotrophy (CSA), the latter is characterized by the accurate segmental distribution of weakness. MMT is also useful for the differentiation between CSA and neuralgic amyotrophy (NA) or that between pyramidal weakness and hysterical weakness.