Proper Performance and Interpretation of Electrodiagnostic Studies. [Corrected

Abstract

The AANEM strongly recommends that EDX procedures be performed by physicians with comprehensive knowledge of neurological and musculoskeletal disorders to assure accurate interpretation and diagnosis. Individuals without a medical education in neuromuscular disorders and without special training in EDX procedures typically are not qualified to interpret the waveforms generated by NCSs and needle EMGs or to correlate the findings with other clinical information to reach a diagnosis. It is also the AANEM's position that the same physician should directly supervise and interpret the NCSs including those performed by an EDX technician. The AANEM believes that interpreting NCS without performing a focused history and physical and having oversight over the design and performance is inappropriate. Nerve conduction studies performed independent of needle EMG studies may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. For this reason, it is the position of the AANEM that, except in unique situations, NCSs and needle EMG should be performed together in a study design determined by a trained neuromuscular physician. There are common diagnoses that depend on performing a needle EMG and combining the needle EMG data with the NCS data. Needle EMG studies are a necessary part of the evaluation in the diagnosis of myopathy, radiculopathy, plexopathy, disorders of the motor neuron, peripheral neuropathies and most disorders of the individual peripheral motor nerves. When the NCS is used on its own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can often be misleading, and important diagnoses will likely be missed. Patients may thus be subjected to incorrect, unnecessary, and potentially harmful treatment interventions. The AANEM is concerned that utilizing only NCSs to make health care decisions provides incomplete diagnostic information, leading to inadequate or inappropriate therapy for some patients and may increase health care costs.