News Express

CMS Finalizes Updates to Physician Fee Schedule

November 13, 2022

On November 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Payment Schedule effective January 1, 2023. AANEM policy staff is diligently reviewing the 3,000+ page rule. Read on for highlights.

Advocacy in Action: State Liaison Leads the Way for Patient Advocacy in Washington and Beyond

October 31, 2022

Mohammad A. Saeed, MD, MS, is one of AANEM’s longest-standing state liaisons and most active members. He’s gone above and beyond meeting with congressional members on his own and building key relationships to help move AANEM’s advocacy efforts forward. Dr. Saeed invited congresswomen Marilyn Strickland (D-WA) in May 2022 and Dr. Kim Schrier (D-WA) in October 2022 to town hall events at his home in Washington to discuss current issues and focuses of Congress with their supporters and guests.

Science News: Extensor Digitorum Brevis Bulk and Associations With Fibular Motor Nerve Conduction Amplitude

October 30, 2022

Prior studies demonstrate fibular compound motor action potential (CMAP) < 4.0 mV predicts impairment of ankle proprioceptive precision and increased fall risk. The authors posit that evaluation of extensor digitorum brevis (EDB) may present a simple surrogate for CMAP amplitude. This study aims to correlate physician evaluation of EDB muscle bulk with CMAP amplitude on nerve conduction study (NCS).

FREE Webinar - What a PM&R Physician Needs to Know About Considering a Career in NM or EDX Medicine

October 27, 2022

AANEM invites medical students, residents, and early-career physiatrists to join experienced physicians at an interactive webinar to explore career options for physiatrists with a sub-specialty focus on neuromuscular (NM) and/or electrodiagnostic (EDX) medicine.

Patient Safety: Percutaneous Sharp Injuries: Primary Prevention

October 17, 2022

Patient Safety: Percutaneous Sharp Injuries: Primary Prevention

Science News: Eculizumab Versus Rituximab in Generalised Myasthenia Gravis

October 16, 2022

A small sub-group of myasthenia gravis (MG) patients is refractory to first-line immunosuppressive medications. Complement-targeted therapies are relatively new in neurological practice but gaining grounds in the landscape of MG management, particularly acetylcholine receptor antibody (AChR)-Ab positive cases.

Science News: Measurement of Excitation-Contraction Coupling Time in Critical Illness Myopathy

October 02, 2022

This study describes a novel electrophysiological method using an accelerometer to measure the excitation-contraction coupling of the soleus muscle for early diagnosis of critical illness myopathy (CIM).

World Limb Girdle Muscular Dystrophy (LGMD) Awareness Day

September 29, 2022

World Limb Girdle Muscular Dystrophy (LGMD) Awareness Day

AANEM Consensus Statement Collaboration with the Heart Rhythm Society

September 13, 2022

The Heart Rhythm Society (HRS) recently published in their journal an international multidisciplinary document titled 2022 HRS Expert Consensus Statement on Evaluation and Management of Arrhythmic Risk in Neuromuscular Disorders that AANEM is pleased to have collaborated on. This document is intended to guide electrophysiologists, cardiologists, other clinicians, and health care professionals in caring for patients with arrhythmic complications of neuromuscular disorders (NMDs).

Science News: Identification of Serum Interleukin 6 Levels as a Disease Severity Biomarker in Facioscapulohumeral Muscular Dystrophy

May 15, 2022

Facioscapulohumeral muscular dystrophy (FSHD) is one of the most common inherited myopathies, presenting as slowly progressive, often asymmetric muscle weakness. Although a gain-of-toxic function secondary to aberrant DUX4 expression is the known etiology, exact pathomechanism is not known. Inflammatory reactions are sometimes seen in muscle biopsies, leading to speculation of the role of inflammatory pathway activation in disease pathogenesis. This retrospective study analyzed serum cytokines in 100 FSHD1 patients to identify potential biomarkers. 

Science News: Systemic Inflammatory Markers in Neuropathic Pain, Nerve Injury, and Recovery

May 15, 2022

Findings of this article highlight the potential role of systemic immune dysregulation and the role of cytokines in focal nerve injury and chronic neuropathic pain. The study provides important information relevant to neuropathic pain and possible biomarkers for future studies. Findings of this article highlight the potential role of systemic immune dysregulation and the role of cytokines in focal nerve injury and chronic neuropathic pain. The study provides important information relevant to neuropathic pain and possible biomarkers for future studies. 

Science News: Effects of Transcranial Direct Current Stimulation Combined with Neuromuscular Electrical Stimulation on Upper Extremity Motor Function in Patients with Stroke

April 28, 2022

This study determines the treatment effects of transcranial direct current stimulation (tDCS) combined with neuromuscular electrical stimulation (NMES) on the motor function of upper extremity (UE) in persons with stroke. The study allows for additive tools physicians can utilize to optimize and improve upon conventional rehabilitation.

Science News: Home-Based Exercise in Autoimmune Myasthenia Gravis: A Randomized Controlled Trial

April 28, 2022

Currently, no evidence-based guideline exists on the amount and type of exercise in the patient with generalized MG and effects on the quality of life. In this study, the authors tried to analyze home-based exercise over a home rowing program over 3 months. Although the exercise was well tolerated, the intention to treat analysis revealed no evidence of improved health-related quality of life.

Science News: Natural History of Facioscapulohumeral Dystrophy in Children: A 2-Year Follow-Up

April 18, 2022

This is a small 2-year follow-up study of genetically confirmed facioscapulohumeral dystrophy (FSHD) cases from the Netherlands. On clinical examination, facial weakness was observed as a sign of disease progression. FSHD clinical score 0-15 and muscle ultrasound Z score appeared to be most promising outcome measures of progression. Despite disease progression, children may still notice improvement in functional capacity, including the 6-minute walk test. Pain, fatigue, and decreased quality of life were common symptoms during follow-up. 

Science News: Mitochondrial Disease in Adults: Recent Advances and Future Promise

April 18, 2022

This article provides an up-to-date review of the clinical and biochemical approach to mitochondrial disorders in adults. The clinical approach algorithm is especially useful. The NM neuro-imaging features will also help clinicians.

Science News: Life Expectancy in Duchenne Muscular Dystrophy: Reproduced Individual Patient Data Meta-Analysis

April 03, 2022

This is a systemic review of published literature on mortality in Duchenne muscular dystroph (DMD) up to July 2020 which focused on publications with Kaplan-Meier (KM) survival curves with age as a time scale. Of the 1,177 articles identified, 14 publications met the inclusion criteria providing data on 2,283 patients of whom 1,049 had died. Median life expectancy was 22 years. Analysis stratified by 3 time periods showed increased life expectancy in more recent patient populations born after 1990 had a median life expectancy of 28.1 years.

Science News: Clinical and Genetic Characteristics in Young, Glucocorticoid-Naïve Boys With Duchenne Muscular Dystrophy

April 03, 2022

This article reports the genotype-phenotype characteristics of the largest international cohort of Duchenne muscular dystrophy (DMD) boys (participants in the Finding the Optimum Corticosteroid Regime for Duchenne Muscular Dystrophy (FOR-DMD)) pretreated with glucocorticoids. Out of 196 boys recruited, 193 were found to have a DMD mutation.

Science News: Ultrasound First for Pediatric Patients in an Electrodiagnostic Laboratory

March 20, 2022

Authors investigated the impact of a US-first approach, adopted in their EMG lab, for pediatric patients. They retrospectively identified pediatric patients who were examined via US prior to EDX tests and those undergoing EDX tests initially. Authors compared the number of nerves stimulated in NCS and the number of muscles sampled in EMG between groups. They also presented two cases to demonstrate the impact of using a US-first approach.

Science News: Is There an Association Between Ulnar Nerve Hypermobility and Neuropathy at the Elbow?

March 20, 2022

This is a review of literature regarding associations between ulnar nerve hypermobility (UNH) and ulnar neuropathy at the elbow (UNE). Case control, cohort, and RCTs were included. Studies diagnosing UNH both with physical exam (3) and US (17) were included. Diagnosis was made with both electrodiagnostic studies and ultrasonography. Studies looking at post op findings, hereditary neuropathy with liability to pressure palsy, polyneuropathy, trauma, and pediatric cases were included. Cadaveric or animal studies were excluded.

Science News: Nitrous Oxide-Induced Myeloneuropathy

March 06, 2022

Nitrous oxide (NO, also known as laughing gas, balloons, whippets) abuse is increasingly recognized as an issue worldwide. Prolonged NO misuse inactivates vitamin B12, causing combined subacute degeneration. The authors studied a cohort of 20 patients with NO misuse. The average patient age was 24 years and mean canister consumption was 148 per day for 9 months. Common presentation included sensory symptoms with paresthesias and gait unsteadiness. In severe cases, patients were bedbound.