In a recent article published in your journal, Kassardjian and the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Quality and Patient Safety Committee have drafted a practical guidance for managing electromyographic (EMG) requests and testing during the coronavirus disease 2019 (COVID‐19) pandemic.1

I read with great interest this study, and I agree that electrodiagnostic (EDX) studies (nerve conduction studies and needle electromyography) are useful tools for the diagnosis of several diseases of the peripheral nervous system and that, in a few cases, can prove to be fundamental in addressing the treatment of some neurological emergencies.

The authors have stratified EDX testing into three categories: urgent, non‐urgent, and possibly urgent. I believe that this interesting and practical guidance could be useful for clinicians who are called on to perform EDX testing in this difficult period.

In the conclusion section, the authors recognize that not all clinical scenarios can be reasonably captured. Conversely, I would like to point out another aspect, that is, the different time windows of the COVID‐19 pandemic and their impact on EDX testing and dedicated neurophysiology staff.

In a first pandemic scenario, referred to as the “contingency standard of care”,2 sufficient medical resources are still available for clinicians. In this circumstance, it is important to minimize the travel of patients and exposure of medical staff, so that non‐urgent EDX studies should be postponed, whereas urgent EDX studies should be performed and the overlap between urgent and non‐urgent studies, the quasi‐urgent category, must be evaluated on a case‐by‐case basis. In this situation, the AANEM guidance is useful and can be easily adopted.

In a second pandemic scenario, referred to as the “crisis standard of care”,2 medical resources may not be available in sufficient quantity for the treatment of all patients, resulting from sickness or home‐quarantine of medical staff. At the same time, service or repair of EMG machines by vendors may be unavailable. In this difficult situation, the practical guidance needs to be rethought, as even urgent EDX studies may not be able to be performed, and clinicians may need to consider different strategies, such as the treatment of Guillain‐Barre syndrome, new onset myasthenia gravis, or cauda equine syndrome, without neurophysiological support to confirm their clinical suspicion. This scenario can be challenging for clinicians and could expose neurological patients to potential harm from medical therapies, so that the risk–benefit ratio of each decision must be clearly discussed with the patient.

In conclusion, EDX studies have a pivotal role in the management of patients with some neurological disorders, but their use must be adapted to the ever‐changing scenarios produced by the COVID‐19 pandemic.

在您的期刊上最近发表的一篇文章中，Kassardjian 和美国神经肌肉和电诊断医学协会 (AANEM) 质量和患者安全委员会起草了一份实用指南，用于在 2019 年冠状病毒病 (COVID-19) 期间管理肌电图 (EMG) 请求和测试） 大流行。1

我非常感兴趣地阅读了这项研究，并且我同意电诊断 (EDX) 研究（神经传导研究和针状肌电图）是诊断周围神经系统几种疾病的有用工具，并且在少数情况下，可以证明是解决某些神经系统紧急情况治疗的基础。

作者将 EDX 测试分为三类：紧急、非紧急和可能紧急。我相信这个有趣且实用的指导可能对在这个困难时期被要求进行 EDX 测试的临床医生有用。

在结论部分，作者认识到并非所有临床情况都能被合理地捕捉到。相反，我想指出另一个方面，即 COVID-19 大流行的不同时间窗口及其对 EDX 测试和专门的神经生理学工作人员的影响。

在第一种大流行情况下，称为“应急护理标准”，2临床医生仍有足够的医疗资源可用。在这种情况下，重要的是尽量减少患者的旅行和医务人员的接触，因此应该推迟非紧急 EDX 研究，而应该进行紧急 EDX 研究以及紧急和非紧急研究之间的重叠，准- 紧急类别，必须根据具体情况进行评估。在这种情况下，AANEM 指南很有用并且可以很容易地采用。

在第二种大流行情景中，称为“危机护理标准”，2由于医务人员生病或居家隔离，可能无法获得足够数量的医疗资源来治疗所有患者。同时，供应商可能无法提供 EMG 机器的服务或维修。在这种困难的情况下，需要重新考虑实用指南，因为即使是紧急的 EDX 研究也可能无法进行，临床医生可能需要考虑不同的策略，例如治疗格林巴利综合征、新发重症肌无力、或马尾综合征，没有神经生理学支持来证实他们的临床怀疑。这种情况对临床医生来说可能具有挑战性，并且可能使神经系统患者受到药物治疗的潜在伤害，因此必须与患者明确讨论每个决定的风险收益比。

总之，EDX 研究在某些神经系统疾病患者的管理中具有关键作用，但它们的使用必须适应 COVID-19 大流行产生的不断变化的情况。