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This text details how to set up and run a clinical Evoked Potential (EP) service. In this revised edition, experts in each area discuss their sections, provide practical guidance and review recent developments. New topics covered include paediatrics, surgical monitoring and cognitive EPs.
Evoked potentials are potentials that are derived from the peripheral or central nervous system. They are time locked with an external stimulus and can be influenced by subjective intentions. Evoked potentials have become increasingly popular for clinical diagnosis over the last few years. Evoked potentials from the visual system are used by ophthalmologists in order to localize the abnormalities in the visual pathway. The otologists are mainly involved in brainstem auditory evoked potentials, while the pediatricians, neonatologists, neurologists and clinical neurophysiologists make use of multimodal stimulation. The psychiatrists and psychologists, generally, examine the slow potentials such as P300 and CNV. Anesthesiologists use short latency somatosensory and visual evoked potentials in order to monitor the effectiveness of the anesthesia. Pharmaco evoked potentials are very promising measures for the quan tification of the effectiveness of drug action on the cerebral cortex. Urologists are more and more involved in pudendal somatosensory evoked potentials and in the intensive care unit evoked potentials are used in order to monitor the functional state of the central nervous system of the patient. This overwhelming number of examinations and exam ina tors clearly demonstrates the need for guidelines and standardization of the methods used. The evoked potential metholody is restricted by the relative poor signal to noise ratio. In many diseases this signal to noise ratio decrease rapidly during the progression of the illness. Optimal technical equipment and methodology are therefore essential.
Evoked potentials have been used for decades to assess neurologic function in outpatient studies and are now routinely used in the operating room during surgery. Illustrated Manual of Clinical Evoked Potentials is a modern, practical guide to performing these studies and interpreting the results. The book is uniquely organized as a singular resource that provides the necessary background for understanding and conducting evoked potential studies. It functions as a multi-purpose text, atlas, and reading session, with numerous examples of studies and findings and discussion of key takeaways. Divided into five chapters, the book opens with an introduction to the basics of data acquisition and interpretation that lays the foundation for the modality-specific chapters that follow. The next group of chapters are in-depth reviews of visual, brainstem auditory, and somatosensory evoked potentials. Each of these chapters lays out the specifics of the modality and study protocol with examples to show how things should—and should not—be done. Sample studies with discussions about how to interpret them highlight a particular aspect of normalcy or pathology. Imaging correlates are provided to emphasize salient points and offer perspective. The final chapter is an overview of the use of evoked potentials during surgery with imaging and case discussions to introduce the reader to this very important application. Key Features Detailed review of methodology of evoked potential studies Many examples of actual patient studies with imaging correlates Interpretation of each evoked potential study presented in detail “Reading session”-like discussion of each example Special chapter on evoked potentials in the operating room
Auditory Brainstem Evoked Potentials: Clinical and Research Applications provides a solid foundation of the theoretical principles of auditory evoked potentials. This understanding is important for both the development of optimal clinical test strategies, and interpretation of test results. Developed for graduate-level audiology students, this comprehensive text aims to build a fundamental understanding of auditory evoked brainstem responses (ABR), and their relationship to normal and impaired auditory function, as well as its various audiologic and neurootologic applications. In addition to covering the classical onset ABR, the book provides a thorough review of sustained brainstem responses elicited by complex sounds, including auditory steady state response (ASSR), envelope following response (EFR), and frequency following response (FFR), and the growing clinical and research applications of these responses. By exploring why certain stimulus manipulations are required to answer specific clinical questions, the author provides the resources needed for students and clinicians to make reasoned decisions about the optimal protocol to use in a given situation. Key Features: * A full chapter devoted to laboratory exercises * Numerous illustrations to help explain key concepts * Description of neural bases underlying amplitude and latency changes * Troubleshooting techniques * End-of-chapter summaries
The long-awaited second edition of an authoritative reference on electrophysiologic vision testing, including detailed information on techniques and problems, basic physiology and anatomy, theoretical concepts, and clinical findings; with extensive new material. This authoritative text is the only comprehensive reference available on electrophysiologic vision testing, offering both practical information on techniques and problems as well as basic physiology and anatomy, theoretical concepts, and clinical correlations. The second edition, of the widely used text, offers extensive new material and updated information: 65 of the 84 chapters are completely new, with the changes reflecting recent advances in the field. The book will continue to be an essential resource for practitioners and scholars from a range of disciplines within vision science. The contributions not only cover new information—important material that is likely to become more important in the next decade—but also offer a long-range perspective on the field and its remarkable development in the last century. After discussing the history and background of clinical electrophysiology, the book introduces the anatomy of the retina and principles of cell biology in the visual pathways at the molecular, physiological, and biochemical levels. It relates these new findings to the techniques and interpretations of clinical tests, including the electro-oculogram (EOG), electroretinogram (ERG), and visual evoked potentials (VEP), which are discussed in detail, as are equipment, data acquisition and analysis, principles and protocols for clinical testing, diseases and dysfunction, and animal testing. Notable additions for this edition include chapters on the origin of electroretinogram waveforms, multifocal techniques, testing in standard laboratory animals, recent advances in analysis of abnormalities in disease, and the applications of these techniques to the study of genetic abnormalities.
Written by experts with extensive clinical and scientific experience, this comprehensive textbook presents the state of the art in auditory evoked potentials. Opening chapters explain the nature of electrical fields that generate surface recorded potentials, summarize the imaging modalities that complement evoked potential studies, and review acoustics and instrumentation. Major sections examine the anatomy and physiology of the auditory periphery, brainstem, and cortex and the principles and clinical applications of auditory, myogenic, visual, somatosensory, and vestibular evoked potentials. Chapters present hands-on laboratory exercises and clinical case studies. A full-color insert includes 3D images from multi-channel evoked potentials and functional imaging.
Brain dysfunction is a major clinical problem in intensive care, with potentially debilitating long-term consequences for post-ICU patients of any age. The resulting extended length of stay in the ICU and post-discharge cognitive dysfunction are now recognized as major healthcare burdens. This comprehensive clinical text provides intensivists and neurologists with a practical review of the pathophysiology of brain dysfunction and a thorough account of the diagnostic and therapeutic options available. Initial sections review the epidemiology, outcomes, relevant behavioral neurology and biological mechanisms of brain dysfunction. Subsequent sections evaluate the available diagnostic options and preventative and therapeutic interventions, with a final section on clinical encephalopathy syndromes encountered in the ICU. Each chapter is rich in illustrations, with an executive summary and a helpful glossary of terms. Brain Disorders in Critical Illness is a seminal reference for all physicians and neuroscientists interested in the care and outcome of severely ill patients.
The vestibular labyrinth consists of ? ve compartments: the lateral, anterior, and posterior semicircular canals, the utricule, and the saccule. At the beginning of the twentieth century, Robert Bárány proposed the caloric test as a clinical test of the lateral semicircular canal. This test enabled clinicians to assess the individual lateral semicircular canal function easily by using the simple method of irrigating the external ear canal with cold or warm water and observing the induced nyst- mus. We believe that the caloric test was a breakthrough in the ? eld of vestibular research. However, as far as the other compartments were concerned, there was no simple clinical test equal to the caloric test for the lateral semicircular canal function. At the end of the twentieth century, the vestibular evoked myogenic potential (VEMP) test was proposed as a new method for assessing the individual saccule function. This test has some unique attributes. First, it uses sound stimulation, even though it is a test of the vestibular system. This appears to be a contradiction n- rophysiologically. As a result, in its early stages there were controversies conce- ing the origin of the responses. However, such controversies have been overcome by basic neurophysiological studies and clinical studies. Above all, sound sensit- ity of the saccular afferents shown in cats and guinea pigs with single-unit recording methods became the main supporting evidence. Nowadays, VEMP is one of the routine clinical tests for balance disorder.
Ideal for DM and DNB in Neurology; Electrodiagnostic Laboratories; Neurologists and MD (Physiology, Psychiatry and Medicine) Clinical neurophysiology has evolved as an extension of clinical examination. This book has three main parts of electrodiagnosis – nerve conduction, electromyography and evoked potentials. The emphasis is on correct method of conducting the test including pitfalls, precautions, and proper interpretation of the results. The normal values of various tests have been provided. The application of nerve conduction, electromyography and evoked potentials in various neurological disorders has been discussed for bedside application and clinical problem solving. The text is amply illustrated by relevant videos, CT and MRI scans, patients' photographs, charts, and tables. The book also provides up-to-date review of relevant clinical and electrophysiological literature, and histopathological correlation with electrodiagnostic tests. These features make this book reader friendly for students and practitioners. Recent advances in clinical neurophysiology have been included in this edition a greatly help in bedside clinical decision making. Additional Feature Complimentary access to online videos along with full e-book.