Annals of Indian Academy of Neurology
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Year : 2007  |  Volume : 10  |  Issue : 1  |  Page : 63

Clinical neurophysiology

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

Correspondence Address:
Abraham Kuruvilla
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
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How to cite this article:
Kuruvilla A. Clinical neurophysiology. Ann Indian Acad Neurol 2007;10:63

How to cite this URL:
Kuruvilla A. Clinical neurophysiology. Ann Indian Acad Neurol [serial online] 2007 [cited 2022 Aug 15];10:63. Available from:

U. K. Misra, J. Kalita

Year of Publication: 2006, 2nd edition, 464 pages

Publisher: Elsevier, a division of Reed Elsevier India Private Limited, New Delhi - 110 065, India

The practice of neurology has witnessed a change over the last few decades with the advent of sophisticated neuroimaging and specific diagnostic tests. Clinical neurophysiology holds a pivotal role in the diagnosis of various neurological disorders. Electrodiagnosis is always considered as an extension of clinical neurological examination. Nerve conduction study (NCS) provides a detailed and quantitative representation of neural physiology and pathology. The information obtained through NCS is not usually pathognomonic of specific disease. However, if often offers identification and classification of disease process and prognosis. In order to perform and interpret NCS effectively, one must have proper understanding and knowledge of anatomy, physiology and pathology of the peripheral nervous system. One should always be aware of the inherent benefits and limitations of the clinical procedures.

Misra and Kalita have successfully blended the neuophysiological techniques with clinical routine in that this book distinctly serves as a pathfinder in solving a diagnostic question pertaining to neuromuscular disease. Although there have been various textbooks in clinical neurophysiology in the western literature, a thorough but practical approach to techniques in electrodiagnosis has been lacking in the Asian sub continent. Altogether, there are 14 chapters. The opening chapter gives an excellent historical review on the evolution of the subspecialty of clinical neurophysiology around the world. Such a lucid historical review is generally missing in the usual textbooks of electrodiagnosis. Chapter 2 deals with the basics of electrical signals and its application in electrodiagnosis. The book consists of three main parts: (i) nerve conduction studies (ii) electromyography and (iii) evoked potentials.

The chapter on NCS starts with the anatomy and physiology of peripheral nerves followed by principles of nerve conduction and physiological and technical variables routinely encountered in an electromyography (EMG) laboratory. Figures maintain the principle of 3 C's: Crisp, Concise and Coherent. They are unquestionably simple and at the same time very "communicative". The chapter then continues with the techniques of various nerve conductions and, the individual nerves are described and studied separately in a systematic order starting from the upper limb. The sub-chapter on nerve conduction of nonlimb nerves is capped with a "hard to come by" technique for conduction study of great auricular nerve. The chapter on autonomic nervous system testing is a superb one in that the authors have made the procedures simple to understand.

The chapter on EMG starts with the anatomy of muscle and an astute description of normal and abnormal discharges. Techniques of electromyography extensively covers the needle insertion for nearly all important muscles encountered in a clinical routine. These illustrations are very simple, accurate and clear to understand.

Chapter 5 covers the clinical application of NCS and EMG in a systematic way. Chapters 6 and 7 discuss the repetitive nerve stimulation and single fiber EMG succinctively. Chapters 8-12 give a detailed clinical application of various modalities of evoked potentials. Pediatric EMG is a separate sub-specialty by itself and, the authors have given a good overview on this less discussed entity. No clinical book meant for diagnostic studies is complete without touching on the prognostication. The authors have capped the book with a brief review on utility of various neurophysiological techniques on prognostication of neuromuscular diseases.

While going through this book, I was vividly reminded of the famous Little Brown spiral manual like Manual of Neurologic Therapeutics which is very popular among neurology residents in the United States of America. Similarly, I feel that this clinical neurophysiology book by Misra and Kalita is a very valuable reference manual in the lapcoat of every trainee in clinical neurophysiolgy for the years to come. Oversimplification is the key to learning and, I congratulate the authors for raising it to the dignity of a fine art.


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