EFTA02048082.pdf

To: Jeffrey Epsteinueeyacation©gmail.comj From: MARK TRAMO Sent Wed 7/13/2016 12:22:29 AM Subject: Re: EMG Report from Dr. Fatimi Thank you for the report, Leslie! JE - Re: EMG/NCS - All the right things were (said to be) done, including EMG of paraspinal muscles. There's always the question of how many penetration sites were recorded in each muscle, which we are not required to document in standard EMG Reports. The number textbooks say we need to sample is 30 sites per muscle, but no one does that any more because of the time/reimbursement tradeoff, even in university EMG labs - doctors are paid not like lawyers and accountants (dollars per hr) but like McDonalds (number of burgers/pts per hour), so everyone (esp private practitioners - cut corners). That said, the results indicate that in 2011 you almost certainly did not have severe denervation or re-innervation changes in leg or lower back muscles. (FYI - Somatosensory Evoked Potentials (SEPs) were not done.) Now that I've seen your MRI, I don't think you need another EMG/NCS study (or SEPs) - your history and physical exam should suffice unless the surgeon insists on electrophysiological studies as part of a pre-op evaluation. Epidural nerve blocks are, in a sense, diagnostic: if the pain improves for at least a few days, the source of the pain is the nerve(s) that was blocked. Patients typically have I, 2, or 3 epidurals over the course of a few months to relieve the pain. Usually the pain relief lasts for weeks after each injection, sometimes months, and only rarely (if ever) is permanent. In view of your MRI findings, a focal decompression at the level of maximum stenosis is probably all you need - a low-risk procedure. I think a consultation (with your MRI in hand) with Dr Cammisa at NYH/HSS would be informative - you can ask about the risks and recovery time and make a decision after the consultation without signing up for surgery on the spot. Hoping you pain is minimal/non-existent at the moment, MT On Mon, Jul II, 2016 at 10:48 AM, wrote: Mark Jude Tramo, MD PhD Dept of Neurology, David Geffen School of Medicine at UCLA Dept of Musicology, UCLA Herb Alpert School of Music Director, The Institute for Music & Brain Science Co-Director, University of California Multi-Campus Music Research Initiative (UC MERCI) EFTA_R1_00583842 EFTA02048082 httpl/www.BrainMustorg http: increi ticsd edu EFTA_R1_00583843 EFTA02048083