Findings from the AANEM Foundation’s 2005 pilot study grant will be presented at the AANEM Annual Meeting October 7-10 in San Diego, California. Dr. Samuel Bierner, a physiatrist at the University of Texas Southwestern Medical Center and AANEM Fellow member, received the $50,000 grant for his study entitled, “Needle EMG Can Predict Response to Epidural Steroid Injection.” The study is complete, with a manuscript being prepared for submission to the AANEM’s official journal, “Muscle & Nerve.” The findings will be presented during the annual meeting’s Abstract Award Presentations on Saturday, October 10, at 10:30AM.

“We were very happy the Foundation funded the study, and we were excited to finish it and be able to present the findings,” said Bierner.

So far, Bierner is considering the study a huge success – not only did it generate findings for its initial intent, but gave strong evidence for EMG as a highly reliable diagnostic tool.

The prospective study demonstrated high interrater reliability for interpretation of needle EMG findings in lumbar radiculopathy when performed by ABEM-certified physicians. Using two blinded ABEM certified experts to review video tracings of needle EMGs from various muscles, agreement was over 90% in the findings and their interpretation.

“There’s always been criticism of EMG by other specialties that it’s subjective, and that knowing a patient’s history may influence the findings because of that,” he said. “We blinded the experts so they knew nothing, and we had very strong reliability in the findings that were consistent. As far as I know, that’s the first time it’s been demonstrated in a blinded, prospective study using EDX experts.”

And while AANEM members already know that EMG is a powerful diagnostic tool, these findings could offer validity to the test with the rest of the medical community because they refute a previous study showing there wasn’t good interrater reliability among EMG readings. And there’s one factor between the two studies that makes all the difference, said Bierner.

“That previous study was done with residents and their supervisors. Our findings prove that having expert examiners made a big difference. This further supports the fact that certification for EDX testing is very important,” said Bierner. “This proves that there isn’t anything wrong with EMG as a test – it’s the people performing the EMGs that make the difference. It’s a reminder that it can be very reliable in the right hands.”

The study was completed at the Veterans Administration in Dallas, TX, where Bierner’s team was able to find a high incidence of positive EMGs. The researchers looked prospectively at the predictive value of needle EMG in lumbar radiculopathy and showed that abnormal needle EMG (defined as membrane instability and not looking at motor unit analysis) predicted short-term pain relief from epidural steroid injections, along with a few other variables, such as age, alcohol use, and disability status.

“We wanted to show that EMG results were predictors of pain relief,” he said. “And our findings showed that patients with abnormal needle EMGs were more likely to experience short-term relief.”

And if getting two manuscripts out of the research wasn’t enough, they found 42 of 80 patients had unequivocally positive needle EMG studies for lumbar radiculopathy, giving them the ability to study retrospectively another group of patients for a third paper.

“We had a significant percentage of abnormal studies, which is great in terms of giving our numbers statistical power,” said Bierner. “Contrary to the expectations of some surgeons, we found that needle EMG frequently showed subacute abnormalities – such as positive waves and fibrillations – in cases which had MRI-documented disk pathology.”

Each year, the Foundation reviews letters of intent for proposed grant funding in the fields of neuromuscular and electrodiagnostic medicine and funds a chosen researcher. The grants are funded completely through individual contributions, corporate donations, and funds raised during the AANEM Foundation’s annual Silent Auction. There are currently five ongoing research projects being funded.