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This technique requires the use of monopolar or concentric bipolar needle electrodes, which are inserted into the body of the muscle to record the electrical activity generated by contraction With concentric needle electrodes, the tip of the wire that runs in the hollow of the needle is in proximity to many muscle bers belonging to several different overlapping motor units; this is the active recording electrode The shaft of the needle, in contact over most of its length with intercellular uid and many other muscle bers, serves as the reference electrode With monopolar electrodes, the uninsulated needle tip is the active electrode, while the reference electrode may be another monopolar needle electrode placed in subcutaneous tissue or a surface electrode on the skin overlying the muscle Patients almost invariably nd this portion of the test uncomfortable and should be prepared by a description of the procedure Rapid and brief needle insertion by the skilled examiner makes the test more tolerable As the electrical impulse travels along the surface of the muscle toward the recording electrode, a positive potential is recorded on the oscilloscope, ie, the recorded signal is de ected downward by convention (at A in Fig 45-5) When the depolarized zone moves under the recording electrode, it becomes relatively negative and the beam is de ected upward (at B) As the depolarized zone continues to move along the sarcolemma, away from the recording electrode, the current begins to ow outward through the membrane toward the distant depolarized region, and the recording electrode

In step 2 of the Chart Designer, I added text for the titles of the chart and the axes, as shown next As you can see, when you enter text in the fields on the left, it appears in the chart by default At this point, if you click the Complete button, you have just built a line chart

Figure 45-4 Compound action potentials evoked in hypothenar muscles by electrical stimulation of the ulnar nerve at the wrist A Patient with myasthenia gravis typical pattern of decrement in rst four responses followed by slight increment At this rate of stimulation (4 per second), the decrement in response does not continue to zero B Patient with LambertEaton syndrome and oat-cell carcinoma typical marked increase toward normal amplitude with rapid repetitive stimulation (20 per second) Horizontal calibration: 250 ms

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The normal record in adults shows somewhat asymmetrical 8- to 12-per-second 50-mV sinusoidal alpha waves in both occipital and parietal regions These waves wax and wane spontaneously and are attenuated or suppressed completely with eye opening or mental activity (see Fig 2-3A) The frequency of the alpha rhythm is invariant for an individual patient, although the rate may slow during aging Also, waves faster than 12 Hz and of lower amplitude (10 to 20 mV), called beta waves, are recorded from the frontal regions symmetrically When the normal subject falls asleep, the alpha rhythm slows symmetrically and characteristic waveforms (vertex sharp waves and sleep spindles) appear (see Fig 19-1); if sleep is induced by barbiturate or benzodiazepine drugs, an increase in the fast frequencies occurs and is considered to be normal A small amount of theta (4- to 7-Hz) activity may normally be present over the temporal regions, somewhat more so in persons over 60 years of age Delta (1- to 3-Hz) activity is not present in the normal waking adult During stroboscopic stimulation, an occipital response to each ash of light may normally be seen (photic or occipital driving) The visual response arrives in the calcarine cortex 20 to 30 ms after the ash of light The presence of such a response indicates that the patient can at least perceive light, and if there is a claim to the contrary, the patient is either hysterical or malingering The evoked visual responses (see further on) are an even more sensitive means of detecting hysterical blindness than occipital driving, since the latter may be absent in normal persons Spread of the occipital response to photic stimulation, with the production of abnormal waves, provides evidence of abnormal excitability (Fig 2-3B and C) Seizure patterns may be produced during this type of EEG testing, accompanied by gross myoclonic jerks of the face, neck, and limbs (pho-.

Through the medium of lengthy EEG recordings as described in Chap 19, many abnormalities associated with sleep can be dem-

For line charts, you can set the manner in which the lines pass between data points: direct, as in the preceding example; as curved lines; or in varying increments To do so, go to the next step in the Chart Wizard, choose Data Series Format | <name of series> | Line Type In all the other examples in this section, we will only add some text to the formatting process, so they all can be developed in a matter of seconds

Figure 2-3 A Normal alpha (9 to 10 per second) activity is present posteriorly (bottom channel) The top channel contains a large blink artifact Note the striking reduction of the alpha rhythm with eye opening B Photic driving During stroboscopic stimulation of a normal subject, a visually evoked response is seen posteriorly after each ash of light (signaled on the bottom channel) C Stroboscopic stimulation at 14 ashes per second (bottom channel) has produced a photoparoxysmal response in this epileptic patient, evidenced by the abnormal spike and slow-wave activity toward the end of the period of stimulation

tomyogenic or photomyoclonic response) or by major convulsions (photoparoxysmal or photoconvulsive response) Such effects occur with some regularity during periods of withdrawal from alcohol and other sedative drugs These responses are to be differentiated from purely myoclonic ones that are produced by contracting scalp muscles and are often visible in the routine EEG Children and adolescents are more sensitive than adults to