neurologist has sent a patient for nerve conduction studies (NCS) and has received the report, but what does it mean? We hope to remove some of the mysteries that may surround NCS. The techniques and how they are affected by disease are described in general terms. These principles can be applied to specific conditions discussed elsewhere. We also discuss the numerous pitfalls that may be encountered with NCS. Understanding these basic concepts will allow you to get the most from your clinical neurophysiology department. NCS are only part of a complete peripheral neurophysiological examination (PNE) and are frequently accompanied by a needle electromyogram (EMG). The combination of both techniques and those detailed in other articles in this issue are often required for a complete diagnostic study. The process of choosing the appropriate tests is the responsibility of the clinical neurophysiologist (CN) and not the referring doctor and is planned as a dynamic series of steps designed to answer specific questions about nervous system function raised by the clinical picture. ABBREVIATIONS c Clinical neurophysiologists can employ a confusing number of terms and abbreviations. Box 1 lists the ones we use frequently.

We evaluated the efficacy of imatinib mesylate in addition to hydroxyurea in patients with recurrent glioblastoma (GBM) who were either on or not on enzyme-inducing anti-epileptic drugs (EIAEDs). METHODS: A total of 231 patients with GBM at first recurrence from 21 institutions in 10 countries were enrolled. All patients received 500 mg of hydroxyurea twice a day. Imatinib was administered at 600 mg per day for patients not on EIAEDs and at 500 mg twice a day if on EIAEDs. The primary end point was radiographic response rate and secondary end points were safety, progression-free survival at 6 months (PFS-6), and overall survival (OS). RESULTS: The radiographic response rate after centralised review was 3.4%. Progression-free survival at 6 months and median OS were 10.6% and 26.0 weeks, respectively. Outcome did not appear to differ based on EIAED status. The most common grade 3 or greater adverse events were fatigue (7%), neutropaenia (7%), and thrombocytopaenia (7%). CONCLUSION: Imatinib in addition to hydroxyurea was well tolerated among patients with recurrent GBM but did not show clinically meaningful anti-tumour activity.

Objective To establish the reliability of fetal magnetocardiography as a method of measuring the Design A prospective study.Setting Wellcome Biomagnetism Unit, Southern General Hospital.Subjects One hundred and six low risk pregnant women at 20 to 42 weeks gestation. Main outcome measuresSuccess in obtaining QRS complexes, P waves and T waves. Correlation of time intervals with fetal outcome. Results The technique was acceptable to pregnant women. A QRS complex was successfully demonstrated in 68 (67 "/ o) of the unaveraged traces. Using off-line averaging techniques on these 68 cases, P waves were obtained in 75 YO and T waves in 72 YO. Although good quality traces were obtained throughout the range of gestational ages, in general it was more difficult below 28 weeks. QRS duration (R2 = 7 %, P = 002) demonstrated a positive linear correlation with increasing gestation. Of the 35 (51 YO) cases with umbilical vein pH analysis available, only one result was less than 7.2. No significant relation was found between measurements of the fetal waveforms and the pH results. Conclusion The technique of fetal magnetocardiography provides a significant advance in the technological field for the demonstration of QRS complexes and the full PQRST waveforms in gestations from 20 weeks onwards. With further technical improvements the clinical impact

Our findings indicate that in asymptomatic volunteers, waist belt and central obesity cause partial hiatus herniation and short-segment acid reflux. This provides a plausible explanation for the high incidence of inflammation and metaplasia and occurrence of neoplasia at the GOJ in subjects without a history of reflux symptoms.

SUMMARY Clinical tests of thermal sensation are poorly quantified and not strictly modality specific. Previous automated thermal testing systems have had limited usefulness with high intraand inter-individual variability. This paper describes an automated thermal system (Glasgow system) which is an extensive modification of previous techniques to answer these criticisms. It comprises a microprocessor-driven Peltier element and utilises the forced choice method of psychophysical analysis to determine the thresholds to thermal stimulation. In a control group of 106 healthy subjects the mean heat threshold for the wrist was found to be 0 23°C (SD = 0.06°C) and the mean cold threshold 0 15°C (SD = 0.05°C). Repeated determinations showed a maximum of 5% intra-individual variation in comparison to previously reported values of up to 150%. through the element to maintain background skin temperature, allowing the heat pumping capacity of the thermode to be reserved exclusively for the test studies.6Simple measurements of thresholds were superseded by the "Marstock method" where the temperature interval between the perceptual thresholds for warm and cold stimuli was defined as the most sensitive index of neural abnormality.79 In this interval, the "warm-cold difference limen", no thermal sensation is appreciated. These short-term studies were repeated over periods of minutes but longer term studies repeated over days showed an unsatisfactory intra-individual variation of up to 150% between estimations.'0 This variability was attributed to central processing mechanisms although variation due to patient bias and reaction time had not been excluded.The most recent studies have used automated control systems to operate the Peltier element and

We have applied our technique for the measurement of thermal thresholds to 25 patients referred with symptoms and signs of small fiber peripheral neuropathy in whom conventional electrophysiological indices were individually within the range of normal values for our laboratory. Vibration threshold determinations were also within normal range. Significant abnormalities of thermal thresholds were noted in all patients. The results indicate that the technique provides an accurate, easily performed and reproducible index of function in small A delta and C groups of nerve fibers.

The DelApp test showed good performance, supporting the utility of objectively measuring attention in delirium assessment. This study provides evidence of the feasibility of using a smartphone test for attentional assessment in hospital inpatients with possible delirium, with potential applications in research and clinical practice.

The single fiber needle electrode (SFNE), which is designed to isolate single muscle fiber action potentials, has played an important role in the diagnosis of myasthenia gravis (MG). However, the concentric needle electrode (CNE) has been recently adopted by some workers to study neuromuscular instability in MG, and reference data have also been obtained in healthy subjects. In this study we wanted to establish whether data acquired using the SFNE is comparable to that obtained using the CNE when studying patients with MG. We established reference data for our laboratory using the CNE for orbicularis oculi (OO) and extensor digitorum communis (EDC). We compared data from 24 MG patients using both SFNE and CNE and found no significant differences in mean jitter values for either muscles. We correlated the neurophysiological data obtained by either electrode with various clinical assessments, the ice pack test, OO and EDC strength measurement, and MGFA classification of disease, and we found no significant relation. We compared discomfort scores for the two needle electrodes for each muscle and found that the discomfort scores for CNE are significantly lower (P = 0.0004). We conclude that the CNE is a useful alternative electrode for studying single fiber potentials, but more reference data from normal control subjects is desirable. Muscle Nerve, 2008.