Electrodiagnosis in Clinical Neurology, 4th ed.

Electrodiagnosis in Clinical Neurology, ed 4

Aminoff M J, ed. Philadelphia, PA 19106-3399, WB Saunders Co, 1999, hardcover, 816 pp, illus, $150.

This book focuses on the clinical applications of electrophysiologic methods and the role of these tests for evaluating the nervous system. The author has attempted to limit the expansion of presentation; however, because clinical electrophysiology has grown considerably since the last edition, he has had to expand this text to keep pace. With 800 pages, it is an imposing volume. In general, the stated approach to the material is to present the reader with physiologic principles, methods, and technical understanding of the tests and their uses. It does not use the case-based presentations or encyclopedic details usually reserved for specialists or trainees.

The book contains 4 sections. The first section is the introduction containing 2 chapters. The first chapter addresses the history of electrophysiology as an aid to clinical diagnosis and electrotherapy. It is a fascinating and well-written exploration of the emergence of electrophysiology. Chapter 2 addresses electrophysiologic equipment and safety. Section II, containing a full quarter of the text, covers electroencephalography, including newer adaptations such as its use in topographic mapping and intraoperative monitoring. It is clearly written and well illustrated.

Electromyography, which is probably the area of most interest to physical therapists, is the focus of the third section. The first 2 chapters (chapters 10 and 11) in this section are devoted to needle electromyography (EMG) with the usual insights into the creation of various waveforms of interest. Needle EM(, findings in various types of clinical disorders are explored. Nerve conduction tests are covered in chapter 11, which is quite thorough and very well illustrated. The effects of variation in conduction sites and electrode placement are well documented, as are anatomical anomalies. Although it is not exactly case-based, this chapter provides considerable insight into specific nerve lesions. There is a separate, detailed, and well-illustrated chapter on disorders of neuromuscular transmission. The author provides excellent insight into normal processes of transmission and the changes that occur in disorders and describes the techniques for assessing such conditions. There is also a short chapter on H-reflex and F-response studies. The remainder of the section includes the less familiar and newer applications of electromyography such as microneurography, the blink reflex, electrophysiologic evaluation of movement disorders, and evaluation of the autonomic nervous system.

Section IV is devoted to evoked potentials and related techniques. The standard visual, brainstem auditory, and somatosensory evoked potentials are presented, along with newer techniques such as electroretinography, motor-evoked and event-related potentials, and intraoperative monitoring. The role and use of several of these tests in infants and children are presented in separate chapters.

Section V is relatively short but contains very timely and excellent presentations on electronystagmography and posturography. Electronystagmography is separated into tests of central function (eg, gaze, saccade, ocular pursuit, and optokinetic tests) and tests of peripheral function (eg, static and dynamic positioning and caloric and rotational tests). The basis and function of these tests are clearly described and well illustrated.

The final section covers electrophysiologic evaluation in special situations, including the evaluation of patients in intensive care units and patients with sleep disorders. The use of neurophysiologic techniques in clinical trials and for patients with suspected neurotoxic disorders is explored. A chapter on the electrophysiologic evaluation of brain death provides knowledgeable and insightful exploration of this difficult topic.

It is difficult to determine how to recommend this book. it certainly accomplishes the stated goals, purposes, and approaches. The text is quite readable and hangs together much better than might be expected of a volume with 42 contributors. Although the book would be invaluable for neurologists, individual physical therapists who actually use clinical electrophysiologic tests are relatively rare. in addition, therapists are usually involved in only one area presented in this text, such as electromyography or electronystagmography and posturography. Therapists may not wish to purchase such a large volume for the coverage of one area located in a relatively small portion of the book. Practitioners whose patients often undergo these tests may wish to have such a resource on hand to gain insights into the procedures. The text would be most beneficial in school and clinical libraries where it would be available as valuable reference material.

Carolyn A Crutchfield, PT, EdD, FAPTA
Georgia State University
Atlanta, Ga

Dr Crutchfield is Professor in the Department of Physical Therapy, where her teaching responsibilities include neuroscience, therapeutic approaches to neurologic dysfunction, functional anatomy, and electromyography.3