Simultaneous measurement of conduction velocity in the neural sensory and motor fibers during segmental stimulation

The study concerned the method of investigation of upper extremity nerves which makes possible a simultaneous measurement of the conduction velocity in the motor and sensory fibres over the whole length of the nerve. Recording of responses was based on the use of surface electrodes which are safe, less painful for the patient, and provide sufficiently great responses without the necessity of using the averaging technique. Owing to simultaneous responses from the motor and sensory fibre from several stimulation sites along the nerve the localization of injury and its type are easier to establish. The method is less time-consuming than the conventional one and may be used by technicians.     

Symmetry of normal motor and sensory nerve conduction measurements

Nerve conduction measurements in normal subjects are assumed to be symmetric, but the normal limits of symmetry have not been determined. Full data on the limits of symmetry for commonly studied nerves are important in the clinical interpretation of nerve conduction data. We selected normal electrodiagnostic studies from archived electromyographic laboratory reports that included bilateral measurements of motor and sensory nerves. Symmetry of nerve conduction measures was confirmed, and only the median and ulnar sensory nerves had significant deviations from symmetry, supporting subclinical nerve damage in the most common dominant hand. The limits of symmetry were determined by calculating the 95th percentile for the differences between sides. For motor and sensory nerves, the range of 95th percentile limits was narrower for measures in upper extremity nerves compared to lower extremity nerves. Several reasons are offered for the wider limits of symmetry in lower extremity nerves. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:498–503, 1998.     

Familial,demyelinating sensory and motor polyneuropathy with conduction block

Both multifocal, demyelinating features and prednisone responsiveness are rare in Charcot–Marie–Tooth (CMT) disease. We report a mother and son with a prednisone‐responsive, multifocal, demyelinating, predominantly sensory polyneuropathy that was associated with an isoleucine92valine polymorphism of lipopolysaccharide‐induced TNF‐alpha factor (LITAF). The mother had a multifocal, acquired, demyelinating sensory and motor polyneuropathy (MADSAM)‐like presentation. The son developed left peroneal neuropathy during acute Lyme disease with a subsequent relapsing, MADSAM‐like illness, despite antibiotic treatment. Both shared prednisone responsiveness and multifocal, demyelinating features electrophysiologically. MADSAM may be familial (FaDSAM) and respond to prednisone. Muscle Nerve 41: 558–562, 2010     

Abnormalities of central motor conduction in Parkinson''s disease

The new technique of magnetic stimulation was used to measure amplitude of the motor evoked potential (MEP) recorded from abductor digiti minimi whilst stimulating at the head, and motor conduction time (MCT) between head and neck. Bilateral studies were made in 12 normal subjects and 56 patients with Parkinson's disease. The amplitudes of the MEPs were were significantly larger (P < 0.05) in the patients (mean 1.6 mV, SD 1.4) compared with the normal subjects (mean 0.9 mV, SE 0.6). MCTs were significantly shorter (P < 0.001) in patients (mean 8.1 ms, SD 1.3) compared with the normal subjects (mean 9.4 ms, SD 1.2). Although the pathophysiological basis of these changes has not been determined, they provide objective measurements which may be clinically valuable in monitoring therapy.     

F responses and central motor conduction in multiple sclerosis

Two electrophysiological investigations were used to study 18 patients with multiple sclerosis--F wave characteristics including amplitude, persistence and frequency, which can provide a measure of motoneurone excitability, and magnetic stimulation of the cortex, which enables measurement of conduction along central motor pathways. There was an increase in the mean amplitude and persistence of the F response in patients with abnormal central motor conduction (CMC), although no correlation between the degree of abnormality of CMC and increase in F response amplitude was found. Increase in mean amplitude and persistence of the F response were also found in patients with normal CMC but clinical evidence of a UMN disorder (spasticity and/or weakness); there was no correlation, however, between any single F response characteristic and any particular clinical sign. CMC appears to be the preferred test for detecting subclinical motor lesions in MS: of the patient sides with normal clinical examination, 36% showed abnormal CMC, whereas 23% showed abnormal F responses.     

Central sensory and motor conduction in vitamin B12 deficiency.

Four patients with subacute combined degeneration were studied through upper and lower limb SEPs recorded with a non-cephalic reference montage and through cortical and spinal magnetic stimulation. Clinical signs were confined to the lower limbs in 3 patients; the remaining patient presented only paraesthesiae in 4 limbs. Median nerve SEPs showed a normal cervical N13 response with a significant increase of central conduction time concerning exclusively the P9-P14 interpeak interval. Central motor conduction to upper and lower limb muscles was abnormal. Nerve conduction studies provided no evidence of peripheral nerve involvement. These electrophysiological findings suggest that in vitamin B12 deficiency the higher segments of the cervical cord are usually affected first and that central sensory and motor conduction studies are sensitive methods for detecting such damage.     

Central motor and sensory conduction in X-linked recessive bulbospinal neuronopathy.

Central conduction was studied in 12 patients with X-linked recessive bulbospinal neuronopathy (XBSN) using percutaneous electrical cortical, cervical and lumbar stimulation and somatosensory evoked potentials (SEPs). The central motor conduction time from the motor cortex to the cervical and lumbar segments of the spinal cord was normal in XBSN. SEPs, however, were abnormal or central sensory conduction time was prolonged in patients with XBSN. These results are consistent with the clinicopathological findings of XBSN in which the primary sensory neurons are involved as well as the lower motor neurons in the CNS, whereas the upper motor neurons are well preserved.     

Retrograde changes in motor and sensory conduction velocity after nerve injury

Summary Nerve section is followed by a reduction of motor and sensory conduction velocity in the proximal segment of the injured nerve. This reduction of velocity is associated with retrograde changes in fiber size. If reinnervation does not occur within the next 1 1/2–2 years, retrograde degeneration of nerve fibers results, and the amplitude of the evoked nerve potential in the proximal segment of the injured nerve decreases. This retrograde degeneration is probably significant in view of the poor results frequently obtained after nerve transplantation which is carried out too late.

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Zusammenfassung Traumatische Nervenläsionen sind regelmäßig von einer Herabsetzung der maximalen motorischen und sensiblen Nervenleitgeschwindigkeit im supraläsionellen Abschnitt gefolgt. Dieser korrespondieren retrograde Faserveränderungen mit Reduktion des Axondurchmessers, wobei wahrscheinlich die dicken, rasch leitenden Fasern bevorzugt betroffen sind. Das Ausbleiben einer Reinnervation innerhalb von 1 1/2–2 Jahren führt vermutlich zur retrograden Faser-Degeneration, da nach dieser Zeit eine starke Erniedrigung des evozierten Nervenpotentials im proximalen Nervenabschnitt resultiert. Diese retrograde Degeneration dürfte für die oft schlechten Ergebnisse nach spät erfolgender Nerventransplantation von Bedeutung sein.

     

Reference data for commonly used sensory and motor nerve conduction studies

Introduction: The goal of this study was to generate reference data for a wide range of sensory and motor nerve conduction studies (NCSs) that are commonly used in routine electrodiagnostic practice. Methods: NCS data were collected from control subjects with a normal neurological examination and no known risk factors for or symptoms to suggest disease of the peripheral nervous system. Thirteen sensory and motor nerves were studied in the upper and lower limbs using standard recording techniques. Quantile regression was used to obtain estimates of the lower (e.g., 5th) percentiles for sensory and motor amplitudes and conduction velocities, as well as estimates of the upper (e.g., 95th) percentiles for distal motor latency and F‐wave latencies. Results: Reference data for sensory and motor amplitudes required adjustment for age; F‐wave latencies required adjustment for gender. Covariate adjustments were not required for other reference data. Data from N = 100 and N = 190 subjects permitted estimation of as low as the 4th and 2nd percentile, respectively, but further increases to N = 296 did not permit estimation of a more extreme percentile. Discussion: Efforts to develop reference data require careful selection of study subjects; sufficient sample size; adjustment for relevant covariates; and appropriate statistical methods for analysis. Reference data that cannot be estimated reliably due to absent potentials or data variability must be interpreted with caution. We present data for a range of clinically applicable reference percentiles, but judgment regarding which is most appropriate for diagnostic purpose awaits empiric evaluation in a disease population. Muscle Nerve 40: 772–794, 2009     

Electrophysiological markers of large fibre sensory neuropathy: a study of sensory and motor conduction parameters

Background:  The frequency of sural sensory nerve action potential (SNAP) abnormalities in large fibre sensory neuropathy (LFSN) is uncertain. When sural SNAPs are normal, the sural/radial amplitude ratio (SRAR) was found to improve diagnostic yield in some studies. Motor parameters have been studied rarely, but may be helpful in this setting.
Methods:  The electrophysiology of 105 consecutive patients with LFSN was reviewed and compared with that of 62 controls. We determined (i) the frequency of abnormal sural SNAPs, (ii) the proportion of patients with normal sural SNAPs but reduced SRAR <0.21 and (iii) the utility of motor studies (motor nerve conduction velocity, compound muscle action potential, F-wave).
Results:  Reduced age-adjusted sural SNAPs were present in 54.3% of all patients. In those with normal age-adjusted sural SNAPs, SRAR <0.21 offered a sensitivity of 52.1% and specificity of 83.9%, and prolonged lower limb F-wave latency >105% of the upper limit of normal (ULN) offered a sensitivity of 29.2% and specificity of 90%. Independently and in combination, both parameters significantly improved diagnostic yield.
Discussion:  The combined use of SRAR <0.21 and/or lower limb F-wave delay >105% of the ULN may be useful in patients with LFSN and normal sural SNAPs.     

Longitudinal conduction studies in hereditary motor and sensory neuropathy type 1

Motor conduction studies were performed serially in 10 patients, ages 10-62 years, with clinical and electrophysiological criteria of hereditary motor and sensory neuropathy type 1 (HMSN-1) over periods of 11-19 years. Median nerve conduction velocity (MNCV) and distal motor latency showed no significant change on serial studies. Mean median compound muscle action potential (CMAP) amplitude values, however, decreased 66% in 8 patients. Observed clinical progression in HMSN-1, over prolonged periods of time, was not associated with MNCV slowing. However, CMAP amplitude reduction, reflecting progressive axonal loss, correlated with clinical deterioration.     

Study of central and peripheral motor conduction in normal subjects

Motor potentials to transcranial and cervical magnetic stimulation and F-wave were recorded in 37 arms of 25 normal subjects. Clockwise and anticlockwise cervical stimulation were performed over C5, C7 and T2 spinous processes. A significant correlation was found between height and measurements of central and peripheral motor conduction. Peripheral motor conduction measured by F-wave derived techniques (Kimura formula) was 0.5 msec higher as compared with responses to cervical magnetic stimulation. The site and current flow direction of cervical magnetic stimulation influenced the amplitude of responses but not their latency: responses were larger in the right arm when the centre of the coil was placed over the C5 spinous process and clockwise stimuli were used. The same results were obtained in the left arm when the coil was reversed.     

Aging influences central motor conduction less than peripheral motor conduction: A transcranial magnetic stimulation study

Introduction: In this study we investigated the effects of aging on corticospinal tract conduction by measuring the corticoconus motor conduction time (CCCT). Methods: Motor evoked potentials were recorded from the right tibialis anterior muscle in 100 healthy volunteers. To activate the most proximal part of the cauda equina, magnetic stimulation was performed using a MATS coil over the L1 spinous process (L1‐level latency). Transcranial magnetic stimulation of the motor cortex was also conducted (cortical latency). To obtain the CCCT, the L1‐level latency was subtracted from the cortical latency. Results: Age was significantly correlated with L1‐level latency, but it was not significantly correlated with CCCT. Conclusions: CCCT is the most direct indicator of corticospinal tract conduction, whereas L1‐level latency reflects whole peripheral motor conduction. Central motor conduction was found to be relatively less affected by aging compared with peripheral motor conduction. Muscle Nerve 000: 000–000, 2012     

Somatosensory evoked potentials,sensory nerve potentials and sensory nerve conduction in hereditary motor and sensory neuropathy type I

Summary Thirty-nine patients from six families with hereditary motor and sensory neuropathy type I and control subjects were included in this study. A neurological deficit score (NDS) was derived from a neurological examination and compared with neurophysiological test findings. Further, sensory nerve conduction velocities (SNCV) were compared with the motor nerve conduction velocities (MNCV). Five patients whom peaks of N11/N13 complex and N20 of the median nerve sensory evoked potential (SEP) could be recorded showed normal interpeak latency. The interpeak separation P14 N20 measured in six patients was normal. These findings point to the normal function of the central conductive pathways. Erb and cervical potentials of the median nerve SEP could be recorded in 10% and 12% of the patients, respectively. In contrast, about half of the patients showed a scalp N20, while in most of them no SNCV could be measured. In six patients far-field potential P14 of the median nerve SEP was the first detectable potential. Therefore, we argue in view of the anatomical structure of the thalamus, that the first generator for synchronizing and amplification of impulses is probably located in the thalamus. A third of the patients had a cortical sural nerve SEP, while no sural nerve potentials could be recorded. No association was found between the SEP findings and the NDS. There was an inverse correlation between median SNCV and the NDS, but no relationship between the former and sensory deficit alone. In 40% of the patients median SNCV and in 13% sural SNCV could be recorded and considered to be severely decreased. In contrast, the majority of the patients had mild to moderate sensory deficit. Furthermore, patients with measurable SNCVs had higher MNCVs and lower NDS than patients without measurable SNCVs.     

Cognitive impairment and central motor conduction time in chronic alcoholics

The non-invasive technique of transcranial magnetic stimulation (TMS) was used in 62 chronic alcoholics to assess the functional status of descending motor pathways. The main aims of this study were: to investigate asymptomatic upper motor neuron dysfunction in alcoholics as well as to assess its relationship with parameters reflecting the intensity of exposure to alcohol; and to evaluate a possible relationship between central motor conduction time (CMCT) prolongation and neuropsychological measures of alcohol-related brain damage. Compared to control subjects, chronic alcoholics exhibited a significant prolongation of CMCT (23 out of 62 subjects). No significant correlation was found between CMCT prolongation and intensity and duration of abuse, presence of peripheral neuropathy, or brain atrophy on CT scans. Prolongation of CMCT from the upper limb correlated significantly with impairment of frontal skills on neuropsychological testing (p<0.01). These findings suggest that TMS may be a sensitive method for the detection in alcoholics of subtle neurological dysfunction, not confined to motor pathways.