Professional Statements and Societal Positions Guidelines
American Association of Neuromuscular and Electrodiagnostic Medicine
The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis. If prognostic information is required on ultimate vocal fold mobility in an individual with vocal fold paralysis that is greater than four (4) weeks and less than six (6) months in duration, LEMG should be performed. LEMG may be performed to clarify treatment decisions in an individual with vocal fold immobility that is presumed to be caused by RLN (2016).
NCS performed independent of needle EMG studies may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. For this reason, it is the position of the AANEM that, except in unique situations, NCSs and needle EMG should be performed together in a study design determined by a trained neuromuscular physician. There are common diagnoses that depend on performing a needle EMG and combining the needle EMG data with the NCS data. Needle EMG studies are a necessary part of the evaluation in the diagnosis of myopathy, radiculopathy, plexopathy, disorders of the motor neuron, peripheral neuropathies and most disorders of the individual peripheral motor nerves. When the NCS is used on its own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can often be misleading, and important diagnoses will likely be missed. individuals may thus be subjected to incorrect, unnecessary, and potentially harmful treatment interventions (2017).
AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy (2018): Electrodiagnostic (EDX) studies are often very helpful in the diagnosis and management of individuals who have or are suspected to have Distal Symmetric Polyneuropathy (DSP). However, EDX studies may not be appropriate in every situation. There are five common scenarios in which EDX studies are likely to be beneficial: (1) determining primary and alternative diagnoses; (2) determining severity, duration and prognosis of disease; (3) evaluating risk of associated problems; (4) determining the effect of medications; and (5) evaluating the effect of toxic exposures.
Limitations
Nerve Conduction Studies
EDX testing with automated, noninvasive nerve conduction testing devices is considered investigational and not medically necessary for all indications, including as an alternative method of performing NCSs.
Screening testing for polyneuropathy of diabetes or end stage renal disease (ESRD) in individuals without clinical deficits is not indicated. Testing for the sole purpose of monitoring disease intensity or treatment efficacy in these two (2) conditions is not indicated.
