Training for Diagnosing Neurological Disorders
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 120 |
| Updated: | 3/24/2019 |
| Start Date: | November 4, 2005 |
| Contact: | Candida Silva |
| Email: | candida.silva@nih.gov |
| Phone: | (301) 496-8295 |
Clinical Neurophysiology: Training and Normative Values
This training protocol has two objectives: 1) to train NINDS fellows in specialized
techniques for diagnosing neurological disorders, and 2) to gather data from healthy
volunteers and from patients with various disorders needed for tests to diagnose disorders of
nerve, muscle, and the areas of the brain controlling movement.
Healthy volunteers and patients with neurological disorders of nerve and muscle who require
specialized diagnostic testing may be eligible for this study. Candidates must be 18 years of
age or older. They are screened with a medical history and neurological examination.
Immediately after screening, participants undergo one or two of the following tests:
- Transcranial magnetic stimulation: This procedure maps brain function. A wire coil is
held on the scalp, and a brief electrical current is passed through the coil, creating a
magnetic pulse that stimulates the brain. During the stimulation, the subject may be
asked to tense certain muscles slightly or perform other simple actions. The stimulation
may cause a twitch in muscles of the face, arm, or leg, and the subject may hear a click
and feel a pulling sensation on the skin under the coil. During the stimulation,
electrical activity of muscles is recorded with a computer, using electrodes (small
metal disks) attached to the skin with tape.
- Electromyography (EMG): This test measures the electrical activity of muscles and is
used to diagnose problems with the nerves or muscles. For surface EMG, electrodes are
filed with a conductive gel and taped to the skin. Needle EMG involves inserting a
needle into a muscle to record the electrical activity. Single fiber EMG uses
specialized needles that allow recording from single muscle fibers. The needle is
inserted into a muscle and the subject is asked to tense that muscle slightly.
- Nerve conduction study: This test measures the speed with which nerves conduct
electrical impulses and the strength of the connection between the nerve and the muscle.
It is done by taping wires on the skin to record the impulses and placing a probe on the
skin to deliver a small electrical stimulus.
- Near-nerve recording: This test is a nerve conduction study that is used to measure
responses from very small nerves. It uses a needle placed under the skin to record the
nerve response.
- Quantitative sensory testing: This test measures how well the subject feels vibration
and cold. A probe that can vibrate or cool down is attached to the subject's finger or
foot. The subject presses a button when he or she feels the stimulus. A computer adjusts
the intensity of the stimulus to find the lowest level the subject can feel.
- Nerve ultrasound: This test uses sound waves to examine the nerves. Warm gel is applied
to the skin and a probe is held on the skin surface.
techniques for diagnosing neurological disorders, and 2) to gather data from healthy
volunteers and from patients with various disorders needed for tests to diagnose disorders of
nerve, muscle, and the areas of the brain controlling movement.
Healthy volunteers and patients with neurological disorders of nerve and muscle who require
specialized diagnostic testing may be eligible for this study. Candidates must be 18 years of
age or older. They are screened with a medical history and neurological examination.
Immediately after screening, participants undergo one or two of the following tests:
- Transcranial magnetic stimulation: This procedure maps brain function. A wire coil is
held on the scalp, and a brief electrical current is passed through the coil, creating a
magnetic pulse that stimulates the brain. During the stimulation, the subject may be
asked to tense certain muscles slightly or perform other simple actions. The stimulation
may cause a twitch in muscles of the face, arm, or leg, and the subject may hear a click
and feel a pulling sensation on the skin under the coil. During the stimulation,
electrical activity of muscles is recorded with a computer, using electrodes (small
metal disks) attached to the skin with tape.
- Electromyography (EMG): This test measures the electrical activity of muscles and is
used to diagnose problems with the nerves or muscles. For surface EMG, electrodes are
filed with a conductive gel and taped to the skin. Needle EMG involves inserting a
needle into a muscle to record the electrical activity. Single fiber EMG uses
specialized needles that allow recording from single muscle fibers. The needle is
inserted into a muscle and the subject is asked to tense that muscle slightly.
- Nerve conduction study: This test measures the speed with which nerves conduct
electrical impulses and the strength of the connection between the nerve and the muscle.
It is done by taping wires on the skin to record the impulses and placing a probe on the
skin to deliver a small electrical stimulus.
- Near-nerve recording: This test is a nerve conduction study that is used to measure
responses from very small nerves. It uses a needle placed under the skin to record the
nerve response.
- Quantitative sensory testing: This test measures how well the subject feels vibration
and cold. A probe that can vibrate or cool down is attached to the subject's finger or
foot. The subject presses a button when he or she feels the stimulus. A computer adjusts
the intensity of the stimulus to find the lowest level the subject can feel.
- Nerve ultrasound: This test uses sound waves to examine the nerves. Warm gel is applied
to the skin and a probe is held on the skin surface.
Objective: This is a training protocol. The goal of this protocol is to train fellows in
advanced physiological techniques used for diagnosing neurological disorders. A secondary
objective of the protocol is to gather normative data for diagnostic neurophysiologic tests.
Study population: Patients and healthy adult volunteers may be studied under this protocol.
Patients must have a clinical indication for the diagnostic test. Most patients will be
enrolled in a primary NIH protocol, and this protocol will serve as a secondary protocol.
Occasionally, patients will be enrolled in this protocol as a primary protocol when they are
referred from hospitals that participate in the NINDS fellowship training program. Healthy
adults will be studied by fellows-in-training to practice a new testing procedure or to
provide normative data when required by changes in instrumentation or laboratory technique.
Design: Testing will be performed during an outpatient clinic visit. One or two of the
following procedures may be performed as clinically indicated: single fiber EMG, macro-EMG,
near-nerve recording, single-pulse transcranial or peripheral nerve magnetic stimulation,
quantitative sensory testing, nerve conduction studies, electromyography, nerve
ultrasonography, or autonomic testing.
Outcome measures: This is a training protocol. No research will be carried out under this
protocol.
advanced physiological techniques used for diagnosing neurological disorders. A secondary
objective of the protocol is to gather normative data for diagnostic neurophysiologic tests.
Study population: Patients and healthy adult volunteers may be studied under this protocol.
Patients must have a clinical indication for the diagnostic test. Most patients will be
enrolled in a primary NIH protocol, and this protocol will serve as a secondary protocol.
Occasionally, patients will be enrolled in this protocol as a primary protocol when they are
referred from hospitals that participate in the NINDS fellowship training program. Healthy
adults will be studied by fellows-in-training to practice a new testing procedure or to
provide normative data when required by changes in instrumentation or laboratory technique.
Design: Testing will be performed during an outpatient clinic visit. One or two of the
following procedures may be performed as clinically indicated: single fiber EMG, macro-EMG,
near-nerve recording, single-pulse transcranial or peripheral nerve magnetic stimulation,
quantitative sensory testing, nerve conduction studies, electromyography, nerve
ultrasonography, or autonomic testing.
Outcome measures: This is a training protocol. No research will be carried out under this
protocol.
- INCLUSION CRITERIA FOR PATIENTS:
Adult patients, over age 18 years old, with a clinical indication for the diagnostic
procedures will be enrolled
- Suspected disorders of neuromuscular transmission, such as myasthenia gravis or
- Suspected Central demyelinating disorders such as multiple sclerosis or
- Suspected Myelopathy or
- Suspected motor neuron disease or
- Suspected Movement disorders that impair intracortical processes or
- Suspected neuropathy or myopathy or
- Suspected autonomic dysfunction
INCLUSION CRITERIA FOR HEALTHY VOLUNTEERS:
Healthy adults, aged 18 years or older, willing to participate
EXCLUSION CRITERIA FOR PATIENTS:
- Patients with implanted devices, such as pacemakers, or metal in the cranium
(excluding dental work) will be excluded from magnetic stimulation studies.
- Children under age 18 will be excluded, since the goal of this protocol is to provide
training experience.
- Subjects who are unable to provide informed consent
- Persons undergoing the autonomic testing will be asked to refrain from smoking,
caffeine, alcohol and vigorous exercise 24 hours before the study. Several medications
should not be taken 48 hours prior to the study; these include tricyclic
antidepressants, antihistamines, cough and cold medications, anti-Parkinson
medication, muscle relaxants, anti-psychosis medications, opioid drugs, and blood
pressure medications. No one is to stop their prescribed medication without discussion
with their primary care physician though the ability to complete all of the autonomic
testing may be affected.
EXCLUSION CRITERIA FOR HEALTHY VOLUNTEERS:
- Medical conditions that require medications that affect the physiological measures
being tested
- History of stroke, peripheral neuropathy or spine surgery
- Implanted devices or metal in the cranium (except dental work) if undergoing magnetic
stimulation
- Persons undergoing the autonomic testing will be asked to refrain from smoking,
caffeine, alcohol and vigorous exercise 24 hours before the study. Several medications
should not be taken 48 hours prior to the study; these include tricyclic
antidepressants, antihistamines, cough and cold medications, anti-Parkinson's
medication, muscle relaxants, anti-psychosis medications, opioid drugs, and blood
pressure medications. No one is to stop their prescribed medication without discussion
with their primary care physician and you may be excluded from the study.
- NIH employees and staff may participate, except if they are EMG Section, OCD, NINDS
employees.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
Phone: 800-411-1222
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