AANEM Glossary of Terms in Neuromuscular and Electrodiagnostic Medicine Compiled by the AANEM Nomenclature Committee Third Edition © AANEM 2015 Muscle & Nerve Supplement 2015 S1 Foreword The field of neuromuscular and electrodiagnostic medicine requires a universal language to communicate effectively. This glossary is the cumulative effort of many individuals over the past several decades. With added knowledge gained through research and innovation, the need to update the extensive list will continue to occur periodically. The original glossary was produced in 1980 with updates in 1987 and 2001. Since the last glossary, the American Association of Electrodiagnostic Medicine (AAEM) has changed its name to the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Electrodiagnostic testing of muscle and nerve function has been enhanced by the addition of neuromuscular ultrasound imaging. Expanding research in this area has prompted the introduction of basic terms regarding ultrasound technology to this glossary. The number of articles with ultrasound in the title in Muscle and Nerve online was only 3 articles in the first six months of 2003 and expanded to 24 articles in a similar timeframe in 2013. Over 50 new terms have been added regarding ultrasound to this glossary with 7 original ultrasound images for illustration. The International Anatomical Terminology text entitled Terminologia Anatomica in 1998 introduced new anatomy terms that are gradually making their way into usage. Examples include the peroneal nerve also known as the fibular nerve and the peroneus brevis and longus muscles also known as the fibularis brevis and longus muscles. The fibular nerve is now added to this glossary. There were only a few terms deleted. The goal of providing educational outreach will be enhanced by adding the glossary to the AANEM website, (www.aanem.org). The 2012-2013 AANEM Professional Practice Committee members who served as the Nomenclature Committee responsible for updating the glossary are acknowledged here: Mary K. Kneiser, MD, Chair Andrea J. Boon, MD Andrew David Brown, MD Lisa D. Hobson-Webb, MD Benn E. Smith, MD William J. Litchy, MD Yuebing Li, MD, PhD Michael Lenihan, MD V. Brandon Thompson, MD Lisa D. Hobson-Webb, MD and Andrea J. Boon, MD provided ultrasound terms and illustrations to introduce basic concepts in neuromuscular ultrasound imaging. A picture is worth a thousand words, especially for a glossary. Francis O. Walker, MD and Michael S. Cartwright, MD, MS provided technical expertise with an additional review of the newly added neuromuscular ultrasound terms. John C. Kincaid, MD provided a final review of the updates to electrodiagnostic medicine terms. Elizabeth A. Conlin, BSEE, ME provided technical support. Thank you to our families for their support allowing the committee members to spend so much time and so many days, nights, and weekends making sure this task was completed. S2 AANEM Glossary of Terms in Neuromuscular & Electrodiagnostic Medicine © 2015 AANEM Table of Contents AANEM Glossary of Terms in Neuromuscular and Electrodiagnostic Medicine SECTION I: ALPHABETIC LIST OF TERMS WITH DEFINITIONS ................................................................... S5 SECTION II: ILLUSTRATIONS OF SELECTED WAVEFORMS ........................................................................ S33 COMPOUND SENSORY NERVE ACTION POTENTIAL ................................................................................ S34 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL (SSEP) MEDIAN NERVE ...................... S34 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL (SSEP) COMMON FIBULAR NERVE . S35 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL (SSEP) POSTERIOR TIBIAL NERVE .. S35 VISUAL EVOKED POTENTIAL (VEP) ............................................................................................................. S36 BRAINSTEM AUDITORY EVOKED POTENTIAL (BAEP) ............................................................................ S36 M WAVE .............................................................................................................................................................. S37 F WAVE ................................................................................................................................................................ S37 H WAVE ............................................................................................................................................................... S38 A WAVE ............................................................................................................................................................... S39 T WAVE ................................................................................................................................................................ S40 BLINK RESPONSES ............................................................................................................................................ S40 REPETITIVE NERVE STIMULATION NORMAL RESPONSE ....................................................................... S41 REPETITIVE NERVE STIMULATION DECREMENTING RESPONSE........................................................ S41 REPETITIVE NERVE STIMULATION INCREMENTING RESPONSE .......................................................... S42 REPETITIVE NERVE STIMULATION NORMAL (N), MYASTENIA GRAVIS (MG), LAMBERT-EATON MYASTHENIC SYNDROME (LEMS) ............................................................................................................... S42 REPETITIVE NERVE STIMULATION PSEUDOFACILITATION .................................................................. S42 INSERTION ACTIVITY ...................................................................................................................................... S43 END-PLATE ACTIVITY ..................................................................................................................................... S44 FIBRILLATION POTENTIAL ............................................................................................................................. S44 POSITIVE SHARP WAVE .................................................................................................................................. S45 MYOTONIC DISCHARGE .................................................................................................................................. S45 COMPLEX REPETITIVE DISCHARGE ............................................................................................................. S46 FASCICULATION POTENTIAL ........................................................................................................................ S46 MYOKYMIC DISCHARGE ................................................................................................................................. S47 NEUROMYOTONIC DISCHARGE .................................................................................................................... S47 CRAMP DISCHARGE ......................................................................................................................................... S48 Muscle & Nerve Supplement 2015 S3 MOTOR UNIT ACTION POTENTIALS ............................................................................................................ S48 SATELLITE POTENTIAL ................................................................................................................................... S49 RECRUITMENT PATTERN/INTERFERENCE PATTERN .............................................................................. S49 SINGLE FIBER ELECTROMYOGRAPH .......................................................................................................... S50 MACROELECTROMYOGRAPHY (MACRO-EMG) ........................................................................................ S51 NEEDLE ELECTRODES ..................................................................................................................................... S52 FULL WAVE RECTIFIED EMG ........................................................................................................................ S52 SYMPATHETIC SKIN RESPONSE ................................................................................................................... S53 SECTION III: ILLUSTRATIONS OF SELECTED ULTRASOUND IMAGES .................................................... S54 SHORT AXIS ULTRASOUND VIEW ................................................................................................................ S55 LONG AXIS STANDARD ULTRASOUND VIEW ........................................................................................... S56 IN-PLANE NEEDLE APPROACH ..................................................................................................................... S57 REVERBERATION ARTIFACT (COMET TAIL) ............................................................................................. S58 ECHOGENICITY HYPERECHOIC/HYPOECHOIC COMPARISON .............................................................. S59 ULTRASOUND ARTIFACT ANISOTROPY ..................................................................................................... S60 ULTRASOUND MODES B MODE/M MODE ................................................................................................... S61 SECTION IV: ABBREVIATIONS .......................................................................................................................