Fall 2012
Electrodiagnostic lab comes to Nevada

synapse: University of Nevada, Reno School of Medicine

Karolyn Witcher and David Ginsburg

Karolyn Witcher and David Ginsburg, M.D., use electrodiagnostic equipment to better evaluate patients with neuromuscular diseases. Photo by Edgar Antonio Nunez.

Accreditation signifies a higher level of diagnostic ability for neuromuscular disease

By Anne McMillin, APR

The University of Nevada School of Medicine earned a new honor signifying it has taken the extra step in its ability to evaluate patients using neurodiagnostic testing entitled nerve conduction studies and electromyography.

Under the direction of neurologist David Ginsburg, M.D., the internal medicine department in Las Vegas became the first lab in Nevada to be accredited by the American Association of Neuromuscular and Electrodiagnostic Medicine, effective June 1, 2012. Ginsburg and his laboratory staff's accreditation further earned the title of "exemplary status."

According to Ginsburg, as of July 2012 there are only about 100 accredited labs in the country.

"This exemplary rating means our quality assurance is at a very high standard."

He added, "We have satisfied stringent criteria set by the association, ensuring physicians can feel comfortable referring their patients to us for diagnosing those with neuromuscular diseases such as spinal nerve root disorders, carpal tunnel syndrome, peripheral neuropathy, muscle disorders and diabetic neuropathy," Ginsburg said.

With the goal of accurately diagnosing the patient, neurologists use the equipment consisting of a nerve stimulator, surface and needle recording electrodes and a laptop computer to determine the location and severity of the neuromuscular problem, and whether the neuromuscular disorder improves over time.

The performance of nerve conduction studies entails the nerve stimulator being placed directly over the nerve, which is then electrically stimulated. The electrical response from the corresponding nerve or muscle is recorded in terms of amplitude, nerve conduction velocity, and latency of the response.

In the second portion, electromyography, the needle recording electrode is inserted within various muscles in order to record electrical activity from the muscles.

The two complementary tests provide a wealth of information about the status of the peripheral nervous system.

"It's an objective way to identify what is going on with the peripheral nervous system, since patients often present with vague symptoms," said Ginsburg, who, working in conjunction with electrodiagnostic technician Karolyn Witcher, uses the diagnostic equipment as an extension of his clinical examination of the patients.

"This procedure is most effective when done by the same physician who actually sees the patient and is familiar with him or her. I will talk to the patient, examine him or her, then perform the test," he explained.

In general, implanted electrical devices such as cardiac pacemakers or spinal cord stimulators are not contraindications for the procedure. Patients on anti-platelet or anticoagulant medications are also typically permitted to undergo electrodiagnostic testing. Testing is not performed over open wounds, and patients with significant edema may need to have the nerve conduction portion of the procedure deferred due to technical considerations.

"We tailor the testing to the patient's presenting condition, which often involves weakness, tingling or numbness. For example, if a patient presents with hand numbness, it may be difficult to distinguish between carpal tunnel syndrome and a pinched nerve from the neck.

"Taking together the patient's history and clinical examination, the electrodiagnostic testing adds an additional critical piece of information which enables me to identify a diagnosis.

"This technology helps me offer patients more accurate diagnoses for improved treatment and outcomes," continued Ginsburg, who has seen this portion of his overall practice grow by 30 percent over the last few months.

While not used for diagnosing central nervous system conditions such as multiple sclerosis or stroke, the electrodiagnostic testing serves as an extension of the clinical evaluation of his patients in his neuromuscular practice, including his multidisciplinary clinics with the Muscular Dystrophy Association and ALS Association.

Furthermore, the diagnostic testing is used in various research protocols in order to evaluate patient responses to cutting edge treatments under clinical investigation.

The five-year accreditation will be maintained by submitting patient test results on an annual basis to the American Association of Neuromuscular and Electrodiagnostic Medicine.

Ginsburg practices at the Patient Care Center at 1707 W. Charleston Blvd., Ste. 220, in Las Vegas.