Current Perception of Contraindications and Complications of Nerve Conduction Studies and Needle Electromyography

Authors: E. Vlčková;  J. Bednařík
Authors‘ workplace: Neurologická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2017; 80/113(1): 43-48
Category: Review Article


Clinical electromyography (EMG) is a key diagnostic tool in many neuromuscular diseases. Despite this, many laboratories do not perform nerve conduction studies (NCS) in patients with a pacemaker or implantable cardioverter-defibrillator. Furthermore, some labs do not perform needle EMG or at least do not examine some of the higher risk muscle groups in patients on anticoagulant or even antiplatelet therapy. In rare cases, EMG examination may also be complicated by leakage, transmission of infectious diseases, pneumothorax, compartment syndrome, or a peripheral nerve lesion. The aim of this study was to summarize current knowledge and recommendations related to these limitations and complications of EMG examination. According to published studies, common as well as repetitive electrical peripheral nerve stimulation can be performed in patients with pacemaker/defibrillator. Stimulation in close proximity to pacemaker/defibrillator should be avoided to prevent electromagnetic interference with their function. No increased systemic risk of clinically significant intramuscular haemorrhage was found in patients on an anticoagulant or antiplatelet therapy. Intramuscular hematomas resulting from needle EMG are usually very small (several millimetres) and clinically asymptomatic. Symptomatic and asymptomatic haemorrhages following needle EMG can occur without any relation to anticoagulant/ antiplatelet therapy. However, they are generally rare and needle EMG is considered to be a safe diagnostic tool. In patients taking anticoagulation medication, thrombotic risk of discontinuing anticoagulation prior to EMG outweighs the risks associated with needle examination while on anticoagulation. All other EMG complications listed above are very rare but relevant. Therefore, it should always be carefully considered whether EMG examination is indicated. General technical and hygienic-epidemiological recommendations for EMG examination should be strictly followed to minimise the incidence of complications.

Key words:
electromyography – artificial pacemaker – implantable defibrillators – electric stimulation – warfarin – anticoagulant agents – antiplatelet agents – haemorrhage – infection – pneumothorax

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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