Safety and pain in electrodiagnostic studies

Discomfort is an unavoidable part of electrodiagnostic (EDX) studies. The most readily modifiable mediator of electromyography (EMG)‐associated pain is muscle selection. Interventions that may reduce pain include vapocoolant spray, ibuprofen, and techniques such as slapping or stretching the skin. Needlestick injuries to health care workers carry the risk of transmitting bloodborne illnesses, but other infectious complications of EDX studies are very rare. EMG probably contributes to asymptomatic hemorrhage in approximately 1% of patients, but clinically significant bleeding has only been reported a few times. Therapeutic anticoagulation does not significantly increase this risk. With standard procedures, there have been no reports of patients developing cardiac arrhythmia from nerve conduction studies. No special precautions are necessary in patients with implantable cardiac devices or intravenous lines. There is a small risk of pneumothorax associated with EMG of the diaphragm and chest wall muscles. Several techniques have been suggested to improve the safety of diaphragm EMG. Muscle Nerve 55: 149–159, 2017Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/136014/1/mus25421_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136014/2/mus25421.pd

Does cerebrospinal fluid analysis have a meaningful role in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150522/1/mus26513.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150522/2/mus26513_am.pd

Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: Support for a hypothesis of posterior primary ramus stretching?

Introduction Denervation of the paraspinal muscles in spinal disorders is frequently attributed to radiculopathy. Therefore, patients with lumbar spinal stenosis causing asymmetrical symptoms should have asymmetrical paraspinal denervation. Methods Seventy‐three patients with clinical lumbar spinal stenosis, aged 55–85 years, completed a pain drawing and underwent masked electrodiagnostic testing, including bilateral paraspinal mapping and testing of 6 muscles on the most symptomatic (or randomly chosen) limb. Results With the exception of 10 subjects with unilateral thigh pain ( P = 0.043), there was no relationship between side of pain and paraspinal mapping score for any subgroups (symmetrical pain, pain into 1 calf only). Among those with positive limb EMG (tested on 1 side), no relationship between side of pain and paraspinal EMG score was found. Conclusion Evidence suggests that paraspinal denervation in spinal stenosis may not be due to radiculopathy, but rather due to stretch or damage to the posterior primary ramus. Muscle Nerve , 48: 198–203, 2013Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99085/1/mus23750.pd

Nerve conduction studies are safe in patients with central venous catheters

IntroductionIt is unknown if central venous catheters bypass the skin’s electrical resistance and engender a risk of nerve conduction study‐induced cardiac arrhythmia. The objective of this study is to determine if nerve conduction studies affect cardiac conduction and rhythm in patients with central venous catheters.MethodsUnder continuous 12‐lead electrocardiogram monitoring, subjects with and without central venous catheters underwent a series of upper extremity nerve conduction studies. A cardiologist reviewed the electrocardiogram tracings for evidence of cardiac conduction abnormality or arrhythmia.ResultsTen control subjects and 10 subjects with central venous catheters underwent the nerve conduction study protocol. No malignant arrhythmias or conduction abnormalities were noted in either group.ConclusionsNerve conduction studies of the upper extremities, including both proximal stimulation and repetitive stimulation, do not appear to confer increased risk of cardiac conduction abnormality in those patients with central venous catheters who are not critically ill or have a prior history of arrhythmia. Muscle Nerve 56: 321–323, 2017Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137740/1/mus25497.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137740/2/mus25497_am.pd

Bilateral nerve conduction studies in the evaluation of distal symmetric polyneuropathy

IntroductionNerve conduction studies are used to aid in the diagnosis of distal symmetric polyneuropathy (DSP). It is unclear whether bilateral lower extremity nerve conduction studies (NCS) are needed when evaluating for suspected DSP.MethodsWe retrospectively analyzed NCS from patients who presented to the University of Michigan electromyography laboratory between July 1, 2016 and December 31, 2017 with symptoms of DSP to assess agreement and correlation between left and right lower extremity NCS parameters.ResultsWe found significant agreement between abnormalities in individual nerve parameters of the left and right lower extremities of 105 patients, most notably in the sural nerve. In the 53 patients with bilateral sural, peroneal, and tibial studies, there was also significant agreement between whether the left and right met electrodiagnostic criteria for DSP (κ = 0.77).DiscussionBilateral lower extremity NCS may have limited utility in the evaluation of suspected DSP. Muscle Nerve, 2019Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151276/1/mus26616.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151276/2/mus26616_am.pd

Electromyography‐related pain: Muscle selection is the key modifiable study characteristic

Introduction : The aim of this study was to estimate the effects of patient, provider, and study characteristics on electromyography (EMG)‐related pain. Methods : Patients undergoing EMG rated their EMG‐related pain after each muscle was studied on a 100‐point visual analog scale (VAS). Investigators recorded the order in which the muscles were sampled, the total time spent with the needle in each muscle, and whether electrical endplate noise was noted. Results : A total of 1781 muscles were studied in 304 patients. Eleven muscles were associated with significantly more or less pain than the others. Endplate noise was associated with more pain (5.4 mm, 95% CI 2.8–7.0). There was a small, but significant effect from needling time (0.02 mm, 95% CI 0.00–0.04). Conclusions : Among factors that electromyographers can control, muscle selection has the greatest impact on pain. Our data include an extensive list of muscle‐specific EMG‐related pain scores. Provider and other study characteristics have little or no impact on EMG‐related pain. Muscle Nerve 49:570–574, 2014Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106736/1/mus23974.pd

Sink or swim: Virtual life challenges among African American families during COVID-19 lockdown

This study explores African American parents’ experiences with using technology toengage their children in meaningful activities (e.g., e-learning) during COVID-19 and its impact on family health. Eleven African American families were recruited through a local health department program from a rural Midwestern community to participate in semi-structured interviews. The majority of participants reported stresses from feelings of “sink or swim” in a digital world, without supports from schools to effectively provide for their children’s technology needs. The COVID-19 pandemic underscored the importance of family-school collaborative engagement and empowerment. Digital technology needs to become part of our school education system so that technology use among African Americans is elevated and families protected against future outbreaks. Further research with a more diverse African American sample is needed

2017 Research & Innovation Day Program

A one day showcase of applied research, social innovation, scholarship projects and activities.https://first.fanshawec.ca/cri_cripublications/1004/thumbnail.jp

Multi-ethnic genome-wide association study for atrial fibrillation

Atrial fibrillation (AF) affects more than 33 million individuals worldwide and has a complex heritability. We conducted the largest meta-analysis of genome-wide association studies (GWAS) for AF to date, consisting of more than half a million individuals, including 65,446 with AF. In total, we identified 97 loci significantly associated with AF, including 67 that were novel in a combined-ancestry analysis, and 3 that were novel in a European-specific analysis. We sought to identify AF-associated genes at the GWAS loci by performing RNA-sequencing and expression quantitative trait locus analyses in 101 left atrial samples, the most relevant tissue for AF. We also performed transcriptome-wide analyses that identified 57 AF-associated genes, 42 of which overlap with GWAS loci. The identified loci implicate genes enriched within cardiac developmental, electrophysiological, contractile and structural pathways. These results extend our understanding of the biological pathways underlying AF and may facilitate the development of therapeutics for AF