{"title":"Visuell Evozierte Potentiale – Technik und klinische Anwendung","authors":"Florian Klinker","doi":"10.1016/j.neulab.2017.02.002","DOIUrl":"10.1016/j.neulab.2017.02.002","url":null,"abstract":"<div><p>Die Visuell Evozierten Potentiale (VEP) bieten die Möglichkeit einer funktionellen Untersuchung der Sehbahn. Ergänzend zur in den letzten Jahren immer weiter optimierten morphologischen, d.h. bildgebenden, Untersuchung ermöglichen VEP die Objektivierung von Sehstörungen oder die Detektion subklinischer Läsionen. Dabei ist eine Latenzverzögerung der beste neurophysiologische Indikator einer Demyelinisierung. Eine spezifische Diagnosestellung allein anhand typischer Befunde ist allerdings trotz etwas unterschiedlicher Befundmuster nicht möglich.</p><p>Die Durchführung der VEP erfordert die Beachtung gewisser Qualitätsstandards. Auf der einen Seite ist das Wissen um biologische (z.B. Mitarbeit, Visus, Vigilanz) und technische Einflussfaktoren (z.B. Elektrodensitz, Reizparameter) unerlässlich für die/den Ableitende(n), um bereits bei der Aufzeichnung Störfaktoren ausschalten zu können. Auf der anderen Seite sind auch für eine qualifizierte Befundung die Erkennung möglicher Artefakte sowie die Kenntnis von den Möglichkeiten und Einschränkungen der VEP notwendig. Insbesondere bedarf es bei der Befundung immer einer Einordnung der Messergebnisse in den klinischen Zusammenhang. Dieser Artikel soll das hierfür notwendige Hintergrundwissen vermitteln.</p></div><div><p>Visual evoked potentials (VEP) provide the possibility for a functional examination of the visual pathway. Complementary to the increasingly sophisticated morphological assessment by imaging techniques, VEP allow for an objective detection of vision disorders and subclinical lesions. In this context, a latency delay is the best neurophysiological indicator of demyelination. Despite slightly different patterns of pathological findings, a definite diagnosis is not possible by means of VEP alone.</p><p>The recording of VEP requires the adherence to certain quality standards. On the one hand, biological (e.g. cooperation, visual acuity and alertness) and technical factors (e.g. position of electrodes and stimulation parameters) should be considered to eliminate confounding factors already present during the recording. On the other hand, a qualified interpretation requires the detection of artefacts and knowledge of the capabilities and limitations of VEP. In particular, the results must be placed in a clinical context to allow for a realistic interpretation. This article should provide the necessary background knowledge.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 2","pages":"Pages 69-80"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2017.02.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45555246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ultraschall des Mittelhirns","authors":"Uwe Walter, Antonia Frenzel","doi":"10.1016/j.neulab.2017.03.001","DOIUrl":"10.1016/j.neulab.2017.03.001","url":null,"abstract":"<div><p>Die transkranielle B-Bild-Sonographie (TCS) des Mittelhirns – insbesondere der Substantia nigra (SN) und der Raphe – wird zunehmend als Instrument zur Diagnostik des Parkinson-Syndroms und weiterer Hirnerkrankungen eingesetzt. Eine ausreichende Schulung und Einarbeitung vorausgesetzt, kann die TCS des Mittelhirns von Ärzten und medizinisch-technischen Assistentinnen/Assistenten gleichermaßen durchgeführt werden. Wichtig ist die Beachtung der korrekten technischen Ausführung (Systemeinstellungen, Vermeidung potenzieller Fehlerquellen). In Zukunft werden digitalisierte Auswerteprogramme die Genauigkeit der Beurteilung der SN-Echogenität erhöhen. Eine interessante neuere Anwendung der TCS ist die Lagekontrolle von Stimulationselektroden zur tiefen Hirnstimulation im Nucleus subthalamicus. Der vorliegende Artikel stellt detailliert die Methodik und die aktuellen diagnostischen Anwendungen der Mittelhirn-Sonographie dar.</p></div><div><p>Transcranial B-mode sonography (TCS) of the midbrain – especially of substantia nigra (SN) and raphe – is increasingly used as a tool for the diagnostics of Parkinson's disease and other brain disorders. Provided adequate instruction and training midbrain TCS can be carried out equally well by the physicians and the technical assistants. The correct technical conductance (system settings, avoidance of potential sources of error) is important to observe. In future, digitized image analysis tools will increase the precision of assessment of SN echogenicity. An interesting novel application of TCS is the position control of deep brain stimulation electrodes in the subthalamic nucleus. The present article provides a detailed overview on the method and the current diagnostic applications of midbrain sonography.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 2","pages":"Pages 81-91"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2017.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46542085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Theorie und Praxis zur Untersuchungsmethode Elektroneurographie","authors":"","doi":"10.1016/j.neulab.2017.03.002","DOIUrl":"https://doi.org/10.1016/j.neulab.2017.03.002","url":null,"abstract":"","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 2","pages":"Page 94"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2017.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71760431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurophysiologische Diagnostik der Amyotrophen Lateralsklerose","authors":"Claas Janssen, Susanne Petri, Katja Kollewe","doi":"10.1016/j.neulab.2017.02.001","DOIUrl":"10.1016/j.neulab.2017.02.001","url":null,"abstract":"<div><p>Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disease leading to the destruction of the motoneurons in the motor cortex and in the anterior horn. For the diagnosis of ALS, no reliable biomarker is available to date. The diagnosis is based on clinical examination and neurophysiological diagnostics.</p><p>The neurophysiological examination thus plays a decisive role in the diagnosis of ALS and its differential diagnosis. In the following study, the neurophysiological investigations (electroneurography, electromyography, and evoked potentials) established in ALS diagnostics are presented and a brief outlook on promising newer investigation techniques in the field of ALS such as Motor Unit Number Index and Muscle ultrasonography are given.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 2","pages":"Pages 55-68"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2017.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43725549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Wann Sonographie peripherer Nerven?","authors":"David Weise","doi":"10.1016/j.neulab.2016.12.001","DOIUrl":"10.1016/j.neulab.2016.12.001","url":null,"abstract":"<div><p>Der hochauflösende Ultraschall hat in den letzten Jahren zunehmende Bedeutung in der Diagnostik peripherer neurologischer Erkrankungen gewonnen. Mit dem Ultraschall lässt sich ein Großteil der peripheren Nerven der oberen und unteren Extremitäten verlässlich darstellen. Der Ultraschall stellt dabei eine komplementäre Methode zur Elektrophysiologie dar, mit der wichtige morphologische Informationen pathologischer Veränderungen der Nerven selbst wie auch deren Umgebungsgewebe erhoben werden können. Sonographisch lässt sich häufig der Schädigungsort präzise lokalisieren und ätiologische Zusatzinformationen erhalten. Die wichtigsten Indikationen des Nervenultraschalls stellen die Diagnostik von Engpasssyndromen, traumatischen Nervenverletzungen, Raumforderungen am peripheren Nerven und (entzündliche) Polyneuropathien dar.</p></div><div><p>High-resolution ultrasound has gained a growing importance in the diagnostic work-up of peripheral nerve disorders in recent times. By means of ultrasound most peripheral nerves of the upper and lower extremities can reliably be visualized. Ultrasound is considered as a complementary method to nerve conduction studies that provides additional information on morphologic changes of the nerve's structure and of its surrounding tissue. It further enables more precise localization of nerval lesion as well as other information about the underlying etiology. The most important indications for ultrasonography are entrapment syndromes like the carpal or cubital tunnel syndrome, traumatic nerve injuries, benign nerve sheath tumors and inflammatory neuropathies.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 1","pages":"Pages 34-44"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2016.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41487274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"NLG und SEP bei peripheren Nervenschädigungen","authors":"Volker Milnik","doi":"10.1016/j.neulab.2016.06.001","DOIUrl":"10.1016/j.neulab.2016.06.001","url":null,"abstract":"<div><p>Es werden Karpaltunnelsyndrom, Loge de Guyon Syndrom, Sulcus Nervi Ulnaris Syndrom, Supinatorlogensyndrom, Interosseus anterior Syndrom, Meralgia parästhetica, Tarsaltunnelsyndrom und das Piriformis Syndrom klinisch kurz beschrieben und die verschiedenen diagnostischen Möglichkeiten und Varianten hierzu beschrieben. Fehlermöglichkeiten bei der Diagnostik der cervikalen Myelopathie werden aufgezeigt.</p></div><div><p>Various diagnostic options and variants of carpal tunnel syndrome, Guyon's canal syndrome, Sulcus nervi ulnar sydrome, supinator syndrome, interosseous anterior syndrome, meralgia paraesthetica, tarsal tunnel syndrome and piriformis syndrome are demonstrated. Possible errors in the diagnosis of cervical myelopathy are shown.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 1","pages":"Pages 1-33"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2016.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46172822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Das Problem mit der schnellen und einfachen Untersuchung der Überleitzeit beim Karpaltunnelsyndrom oder „Einen Fehler machen und ihn nicht korrigieren, das erst heißt wirklich einen Fehler machen“–Konfuzius, *551 v. Chr. †479 v. Chr. Chinesischer Philosoph","authors":"Helmut Buchner","doi":"10.1016/j.neulab.2016.10.003","DOIUrl":"10.1016/j.neulab.2016.10.003","url":null,"abstract":"<div><p>Die Untersuchung der distal motorischen Latenz ist Standard zur Diagnose der Karpaltunnelsyndroms. Obwohl einfach auszuführen birgt sie einige Fehler. Die gilt es zu erkennen und zu vermeiden. Dazu dienen Standard Operating Procedures (SOPs), die die Untersuchung sehr detailliert beschreiben und damit deren Sicherheit erhöhen.</p></div><div><p>The examination of the distal motor latency is standard for the diagnosis of carpal tunnel syndrome. Although simple to run, it contains some errors. They must be recognized and avoided. Standard Operating Procedures (SOPs) are used to describe the investigation in a very detailed manner and thus increase their safety.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"39 1","pages":"Pages 45-53"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2016.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42789245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Die Ableitung der Gehirnströme im Wandel der Zeit","authors":"Anne-Katrin Baum","doi":"10.1016/j.neulab.2016.09.007","DOIUrl":"10.1016/j.neulab.2016.09.007","url":null,"abstract":"<div><p>Seit der erstmaligen Registrierung des menschlichen EEG durch Berger ist die Elektroden- und Registriertechnik einer kontinuierlichen Entwicklung unterworfen. Stets war dieses Verfahren aber einer Anwendung in Arztpraxen oder Kliniken vorbehalten. Eine Neuentwicklung der Magdeburger Universitätsklinik für Neurologie und der Fa. Nielsen gestattet nunmehr die Ableitung mit Trockenelektroden und drahtloser Datenübertragung. Dies ist die Voraussetzung für die Ableitung des EEGs in der Häuslichkeit der Patienten (‚Home Monitoring‘) und somit für eine dezentrale Patientenbetreuung.</p></div><div><p>Ever since Hans Berger invented the EEG, electrodes and recording techniques of brainwaves have been developed constantly. Traditionally, this has always been reserved for hospitals and doctor's practice only. Due to the collaboration and innovation between the Neurology of the Universitätsklinik Magdeburg and Fa. Nielsen, recordings with dry electrodes as well as wireless data transfer are now possible. Both are essential requirements to enable ’Home Monitoring’ and therefore a decentralised patient care.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"38 4","pages":"Pages 177-183"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2016.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55128480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regionale bzw. umschriebene Veränderungen im EEG","authors":"Frank Böhme","doi":"10.1016/j.neulab.2016.09.001","DOIUrl":"10.1016/j.neulab.2016.09.001","url":null,"abstract":"<div><p>Das Wissen über das Ten-Twenty-System, den Elektrodenbezeichnungen, den technischen Parametern (Differenzverstärker-/Polaritätsprinzip) und der Identifizierung von Artefakten wird in diesem Artikel überwiegend als vorausgesetzt angenommen. Der sog. „Herd“ oder „Fokus“ in einer EEG-Ableitung kann durch die sichere Anwendung von Verschaltungen bzw. Montagen im digitalen EEG relativ sicher identifiziert werden. Die genaue Beobachtung des Patienten und eine unterstützende Dokumentation während der EEG-Ableitung sind zwingend und vermeiden Fehlinterpretationen bei der Befundung.</p></div><div><p>The knowledge about the Ten-Twenty System, the designation of the electrodes, the technical parameters (differential amplifier, the principal of polarities) and the identification of artifacts are presupposed in this article. The so-called “focus” in an EEG derivation can be revealed with high probability by applying connections or assembly in a digital EEG. To avoid misinterpretations of the report, it is mandatory to observe the patient keenly and documentary very well while EEG derivation.</p></div>","PeriodicalId":35874,"journal":{"name":"Neurophysiologie-Labor","volume":"38 4","pages":"Pages 151-171"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.neulab.2016.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55128028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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