Interrelationship among nerve conduction velocity, amplitudes of compound muscle and compound nerve action potentials in diabetic neuropathy]

In order to clarify the relationship among amplitudes of compound nerve action potential (CNAP), compound muscle action potential (CMAP) and nerve conduction velocity parameters, data of nerve conduction studies were analyzed in 102 patients with diabetes mellitus. In motor conduction studies CMAP amplitudes after stimulations at the distal nerve trunk, and the polyneuropathy index (PNI), a mean percentage of normal for 12 indices from 4 nerves concerning to the velocity or long distance latency, were evaluated. CNAP was recorded in the median and ulnar nerves from an intrafascicularly inserted microelectrode at the elbow after wrist stimulation. CMAP amplitudes were high in the median and ulnar nerves, and were reduced in the tibial and peroneal nerves. A close relationship was found between PNI and CNAP amplitudes. Among CMAP amplitude parameters tibial nerve, not median or ulnar nerves, had a good correlation with PNI and CNAP amplitude. Along with the progression of diabetic neuropathy, neuropathic signs or symptoms become conspicuous, and nerve conduction velocity drops as is expressed by the PNI level, which reflects the change in nerve conduction velocity in the upper and lower limbs. At the same time CNAP amplitude or CMAP amplitude in the tibial nerve decreases, but in nerves of the upper limb CMAP amplitude doesn't always decrease. So, tibial nerve is best among CMAP amplitude parameters in evaluating the degree of diabetic neuropathy. It is necessary to judge the degree of diabetic neuropathy after due consideration of these facts.     

Electrophysiological study of neuromuscular function in a population poisoned by lead

A comprehensive electrophysiological examination of the peripheral nervous system was carried out in 12 patients who proved to be toxicated with lead (high lead blood levels, and diminished activity of the delta-aminolevulinate dehydratase, ALA D, in erythrocytes). Maximal motor nerve conduction velocities and terminal latencies were investigated in the median, radial and deep peroneal nerves. Also the amplitude of the evoked muscle response (M wave) was measured in thenar, extensor longus and extensor digitorium brevis muscles. Sensory conduction velocity and amplitude of the nerve compound action potential were measured at the median nerve. Tibialis anterior muscle responses to deep peroneal nerve repetitive stimulation were also explored. Conventional needle electromyogram was performed in the deltoid and tibialis anterior muscles. Slight diminished motor and sensory conduction velocities were found as well as a reduction of the amplitude of the evoked muscle response of the compound sensory action potential. Four out of the 12 patients tested showed either decremental or incremental amplitude of the muscle response with nerve repetitive stimulation. A electromyographical diminished interference pattern was found in all patients tested. Most of the remaining motor unit potentials were fragmented or polyphasic. Just one patient disclosed potentials of enhanced duration and amplitude. No relationship was found between blood lead levels or ALA D erythrocytes concentration and the different electrophysiological tests performed, except between reduced ALA D concentration and diminished amplitudes of the M wave and of the sensory compound action potential, and also between ALA D and diminished radial motor conduction velocity.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of temperature on human compound action potentials.

The upper limbs of 10 healthy subjects were cooled and then warmed over physiological temperature ranges. The compound action potentials of median digital nerves, median sensory nerve at the wrist, radial sensory nerve at the wrist, and median thenar muscle, all showed progressive reduction in latency, amplitude, duration and area during rising temperature. Our studies suggest that the sensory compound action potential changes occur predominantly because of the summated effects of reduction in the duration of the action potentials of single myelinated fibres, although disproportionate increase in the conduction velocity of larger myelinated fibres also plays a role.     

Nerve conduction during Wallerian degeneration in the baboon

Conduction in the lateral popliteal nerve of the baboon was studied during the course of Wallerian degeneration. Six nerves were examined. In each case the muscle response to nerve stimulation and the ascending nerve action potential were recorded daily until the nerve became inexcitable. The muscle response to nerve stimulation disappeared after four to five days, but ascending nerve action potentials could be recorded for a further two to three days. There was no change in maximal motor conduction velocity or in distal latency until the muscle response to nerve stimulation was severely reduced in amplitude. At this stage there was a consistent increase in distal latency, sometimes associated with a mild reduction in maximal motor velocity in the leg. There was no change in the velocity of ascending nerve action potentials. Histological studies confirmed the presence of degeneration in the terminal parts of the intramuscular nerve fibres at a time when the proximal parts of the same fibres were relatively normal.     

Evoked muscle action potentials from regenerated rat tibial and peroneal nerves: synthetic versus autologous interfascicular grafts

To compare peripheral nerve regeneration across bridging synthetic tubular implants with ordinary autologous transplantation, we recorded evoked muscle action potentials 3 months after transection, following direct stimulation of rat tibial and peroneal nerves. Significantly, with autologous transplantation we were able to evoke compound muscle action potentials in all but one case (this having a 15-mm gap). Pooling the groups together, compound action potentials could be recorded in 15 of 45 cases that had regenerated through 13- to 16-mm gaps. Potentials in the synthetic implant-treated group tended to show more temporal "scattering" in the late phases of the EMG response. No differences were found in compound muscle action potential amplitudes and duration, or terminal motor conduction velocity, between both experimental groups, between different artificial tubuli, between different gap lengths, or between the peroneal and tibial nerves. The overall values were remarkably lower than in nontransected controls, about 25% of the compound muscle action potential normal amplitude voltage and 60% of the terminal motor conduction velocity.     

Peripheral motor and sensory nerve conduction studies in normal infants and children.

OBJECTIVE: There are few data on electrophysiological data of motor and sensory fibres during nerve maturation. The aim of this study is to investigate the evolution of nerve conduction in the upper and lower limbs during the first years of life. METHODS: The study comprised 92 normal infants and children aged from 1 week to 6 years. Using surface electrodes, the investigation included the following data: (1) motor conduction velocity (MCV), corrected distal motor latency (DML) to a standard distance, and F-waves of the median, ulnar, peroneal and tibial nerves; (2) sensory conduction velocity (SCV) of the median and tibial nerves; and (3) amplitude and morphology of the muscle and sensory action potentials. RESULTS: Maximal MCV and SCV in the neonatal period was about half of adults; there was a steep conduction increase during the first year of life, adult values being reached around age 4. In the neonatal period corrected DML was greater than in adults with a further decrease during the first year. F-wave latencies also decreased during the first year with increase at the end of the study. CONCLUSIONS: This study corroborates the fact that 'maturation' of MCV and SCV occurs during the first 5 years of life, especially in the former. Evolution of DML is accounted for using correction. F-wave latency changes are explained both by an increase in MCV, and extremity growth.     

Effects of chronic lithium treatment on the peripheral nervous system.

BACKGROUND: Although lithium carbonate is widely used in the treatment of mood disorders, symptoms suggesting toxic effects on the peripheral nervous system may emerge even in subjects whose serum lithium levels remain within the recommended therapeutic range. METHOD: Electroneuronographic (ENG) parameters (motor nerve conduction velocity of peroneal and median nerves, sensory nerve conduction velocity of sural and median nerves, amplitude of motor potential of peroneal and median nerves, and amplitude of sensory action potential of the median nerve at the wrist and the sural nerve) were investigated in 2 groups (N = 34) of patients suffering from bipolar affective disorder (DSM-III-R, DSM-IV) undergoing maintenance treatment with lithium carbonate for at least 1 year (mean = 2.06 years) in monotherapy. For 12 patients, ENG results were compared with pretreatment values, whereas in the other 22 cases, only data relevant to posttreatment were available. Fifty-four healthy subjects and 20 patients with recurrent major affective disorder (unipolar and bipolar) never treated with lithium made up the comparison groups. RESULTS: Compared with the 2 comparison groups, patients on chronic lithium treatment showed significant reduction of motor nerve conduction velocity of peroneal and median nerves, sensory nerve conduction velocity of sural and median nerves, amplitude of motor potential of peroneal and median nerves, and amplitude of sensory action potential of the median nerve at the wrist and the sural nerve. The comparison with the assessment made prior to lithium treatment also showed significant changes; after a period of treatment with lithium varying from 2 to 8 years (mean = 5.2 years), significant reductions were found on motor and sensory nerve conduction velocity and on amplitude motor potentials and sensory action potentials. CONCLUSION: Chronic maintenance treatment with lithium affects the peripheral nerves, even if the impairment rarely is such as to warrant discontinuation of treatment. Monitoring of ENG results could be useful for the early detection of neurotoxicity of lithium.     

The effects of axotomy on the conduction of action potentials in peripheral sensory and motor nerve fibres.

Medial gastrocnemius and sural nerves in one hindlimb of the cat were transected and prevented from regenerating. After periods ranging from 29-273 days, compound action potentials were recorded from axotomised and contralateral control nerves. The amplitude and integrated area of action potentials decreased and conduction velocity slowed following axotomy. The area under compound action potentials generated by stimulating sensory fibres declined significantly faster than that generated by stimulating motor fibres. Analysis of changes in whole nerve conduction velocity distributions showed that the velocities of fast conducting sensory fibres decreased at the most rapid rate. The conduction velocities of motor fibres and slow sensory fibres declined at significantly slower rates. The loss of electrical activity in the largest sensory nerve fibres following axotomy, may play a role in determining the faster rate at which their action potentials deteriorate.     

Neurophysiological impairments in multiple sclerosis—Central and peripheral motor pathways

A systematic review of the literature was conducted comparing neurophysiological outcomes in persons with multiple sclerosis (PwMS) to healthy controls (HC), in studies of the central nervous system (CNS) function comprising motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) and in studies of the peripheral nervous system (PNS) function comprising electroneuronography (ENG) outcomes elicited by peripheral nerve stimulation. Studies comparing neuromuscular function, assessed during maximal voluntary contraction (MVC) of muscle, were included if they reported muscle strength along with muscle activation by use of electromyography (EMG) and/or interpolated twitch technique (ITT). Studies investigating CNS function showed prolonged central motor conduction times, asymmetry of nerve conduction motor pathways, and prolonged latencies in PwMS when compared to HC. Resting motor threshold, amplitude, and cortical silent periods showed conflicting results. CNS findings generally correlated with disabilities. Studies of PNS function showed near significant prolongation in motor latency of the median nerve, reduced nerve conduction velocities in the tibial and peroneal nerves, and decreased compound muscle action potential amplitudes of the tibial nerve in PwMS. ENG findings did not correlate with clinical severity of disabilities. Studies of neuromuscular function showed lower voluntary muscle activation and increased central fatigue in PwMS, whereas EMG showed divergent muscle activation (ie, EMG amplitude) during MVC. When comparing the existing literature on neurophysiological motor examinations in PwMS and HC, consistent and substantial impairments of CNS function were seen in PwMS, whereas impairments of the PNS were less pronounced and inconsistent. In addition, impairments in muscle activation were observed in PwMS.     

A micro-electrode study of peripheral neuropathy in man. Part 2. Responses to conditioning stimuli.

Surface, needle and micro-electrode recordings were obtained from sensory nerves of patients with various types of peripheral neuropathy. Changes in amplitude and conduction velocity of nerve action potentials were measured after a single conditioning stimulus and after tetanic stimulation for 2 min. In patients with hereditary forms of axonal degeneration (AD), recovery processes of nerve fibres of all conduction velocities were normal; in acquired forms of AD fibres with conduction velocity less than 30 m/sec had greater and more prolonged post-tetanic depression than control nerves of similar conduction velocity. Where neuropathy was associated with segmental demyelination (SD), fibres of all conduction velocities had prolonged recovery processes after both single and tetanic stimulation. The changes were especially marked at higher skin temperature, and were greater than the changes seen in nerves with acquired forms of AD. Finally, 2 sural nerves were studied during the process of Wallerian degeneration after a biopsy had been obtained proximally, and recovery processes did not change during the period of degeneration. Perceptual abnormalities were similar in AD and SD. It is suggested that changes in recovery processes of nerve fibres with segmental demyelination or regeneration after injury contribute to the perceptual abnormalities which occur in clinically encountered peripheral neuropathies.     

Recovery of nerve conduction after a pneumatic tourniquet: observations on the hind-limb of the baboon

A small pneumatic cuff inflated around the knee was used to produce tourniquet paralysis in baboons. A cuff pressure of 1,000 mm Hg maintained for one to three hours produced paralysis of distal muscles lasting up to three months. Nerve conduction studies showed that most of the motor fibres to the abductor hallucis muscle were blocked at the level of the cuff and that they conducted impulses normally in their distal parts. There was a significant correlation between the duration of compression and that of the subsequent conduction block. When tested two to three weeks after the tourniquet, the amplitude of the response of m. abductor hallucis to nerve stimulation distal to the cuff was usually slightly reduced compared with the precompression figure. This was assumed to mean that a small proportion of the motor fibres had undergone Wallerian degeneration as a result of compression. Maximal motor conduction velocity was reduced in recovering nerves. It was also reduced when a cuff pressure of 500 mm Hg was used, which was insufficient to produce persistent conduction block. In such cases a reduced velocity without evidence of block could be demonstrated 24 hours after compression. Ascending nerve action potentials were recorded from the sciatic nerve in the thigh, with stimulation at the ankle. Before compression the fastest afferent fibres had a significantly higher velocity than the fastest motor fibres in the same nerve trunk. Results after compression suggested that the high-velocity afferent fibres had a susceptibililty to the procedure similar to that of the fastest motor fibres.     

Friedreich's ataxia: electrophysiological and histological findings

ABSTRACT- Electromyography was performed, and motor and sensory nerve conduction velocities were measured in 19 patients definitely affected by Friedreich's ataxia. Biopsy of the sural nerve was also performed in 9 patients.
Most patients presented a moderate to severe loss of motor units, a significant increase in mean duration of motor unit potentials, and in the incidence of polyphasic potentials. Short-lasting spontaneous activity was rarely seen. Conduction velocity along the motor and sensory fibres of the median and tibial nerves was moderately slowed, while distal conduction time to muscle was significantly increased and the sensory orthodromicallyevoked response markedly reduced. Intraoperative electrophysiological recordings obtained during biopsy of the sural nerve in 4 patients were consistent with the changes conventionally observed in the median, tibial and sural (6 patients) nerves.
Quantitative histology revealed a reduced number of total myelinated fibres with a severe loss of large fibres, and a moderate loss of fibres of less than 7 μm in diameter. In teased nerve fibre preparations, the most evident abnormality consisted of fibres with uniformly short internodal length, while signs of remyelination were less prominent. Signs of active axonal degeneration were rarely observed in electron microscopy.
Electrophysiological and histological findings were uniformly distributed, and the changes were neither related to the duration nor to the severity of the clinical condition.     

Length dependence of variables associated with temporal dispersion in human motor nerves

Temporal dispersion in motor nerves is associated with changes of amplitude, area, duration, and Fourier spectra of compound muscle action potentials (CMAPs) when comparing responses to proximal and distal stimulation. These changes depend on the length of the nerve segment. To quantitatively assess this dependence, motor conduction studies of nerve segments of various lengths were performed in the median, ulnar, and tibial nerves of 86 test subjects, aged 4 to 73 years. Amplitude, area, duration, and spectral energy above 49 Hz of CMAPs were measured. Values after distal and proximal stimulation of each nerve segment were compared to determine amplitude decay, area decay, protraction, and high-frequency attenuation. A significant length dependence of amplitude decay was found in the tibial and ulnar nerves, of area decay in the median and ulnar nerves, and of CMAP duration in the ulnar and tibial nerves. The length dependence of the high-frequency attenuation was significant in all nerves studied. This report provides normative data for variables associated with temporal dispersion.     

The excitation of the fibers of the funiculus dorsalis medullae spinalis during the stimulation of different groups of cutaneous and muscle nerve fibers in the cat]

Electric stimulation of various groups of fibres of cutaneous and muscle nerve of cat has been studied for its effect on action potentials in the gray dorsal column fibres, Registration was performed at the level L2--L3 from ipsi- and contralateral dorsal columns, using needle electrodes. Action potentials of dorsal columns, arisen by stimulation of cutaneous nerves, had a more complex form than those of stimulated muscle nerves. Nonmyelinated fibres of a cutaneous nerve are shown to relate to those of dorsal columns. Excitation of high-threshold A- and C-fibres activates the most fast-conducting fibres of dorsal columns. When a stimulus was applied to all fibres of the cutaneous nerve, the action potentials with conduction velocities of 146-0.24 m/s were recorded in dorsal columns. It was shown that such conduction velocities remained in dorsal columns to level C7. Stimulation of muscle nerves excited only myelinic fibres of dorsal columns, the conduction velocities ranging from 90 to 2.3 m/s. By alternating stimulation of either nerve with a 30-300 ms interval we decreased the action potential amplitude of the nerve that was the second to be stimulated. It is likely be related to convergence of the cutaneous and muscle nerve inputs in the spinal cord on the same neurons. A suggestion is made that faster transfer of high-threshold cutaneous signals in dorsal column are associated with the necessity of rapid information about damaging stimulation.     

Reduced sensory and motor conduction velocity in 25-week-old diabetic [ ] mice

Motor and sensory conduction velocities were measured in sural and tibial nerves of 25-week-old genetically diabetic ( ) mice and their nondiabetic littermates. For motor conduction velocity determination, the sciatic nerve was stimulated at the hip and the tibial nerve subsequently stimulated at the ankle while recording interosseous muscle potentials from needle electrodes placed in the foot. Sensory conduction velocities were determined by recording compound action potentials directly from sural and tibial nerves at the ankle after sciatic nerve stimulation. Control and diabetic conduction velocities were compared by Student's t test. The motor conduction velocity was reduced by approximately 20% from the control, and the distal motor latency was increased in mice by 22% more than the control latency. Conduction velocity was also reduced in some sensory fibers, an observation not previously reported in the mouse. Sensory fibers most severely affected were the faster-conducting fibers of the sural nerve, whose conduction velocity was decreased by 18% from the control. Slower-conducting sensory fibers in sural and tibial nerves were only midly affected, whereas fast-conducting sensory fibers of the tibial nerve appeared to remain normal. These data suggest that not all nerve fibers react alike to the diabetic state in the genetically diabetic ( ) mouse.     

Neuromuscular consequences of prolonged hunger strike: an electrophysiological study.

OBJECTIVES: The purpose of this study was to determine the electrophysiological consequences of neuromuscular and central nervous system involvement in a group of patients presented with the neurological complications of a long-term hunger strike (HS). METHODS: Motor and sensory nerve conduction (NCV), F wave, somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies were performed in 12 male and 3 female patients (mean age: 29.4) following HS. RESULTS: All patients whose weight loss was 11-31 (mean: 22.8) kg after 69-day HS, had neurological findings consistent with Wernicke's encephalopathy or Wernicke-Korsakoff syndrome. Abnormally prolonged latency and/or low amplitude sensory nerve action potentials were found in 7 patients. The amplitudes of compound muscle action potentials were significantly reduced in ulnar, median and tibial motor NCV studies as compared to the controls. F waves elicited by median nerve stimulation at wrist and muscle responses evoked by cervical and lumbar magnetic stimulation had significantly prolonged latencies. MEPs recorded from the lower extremities showed a slight prolongation in central conduction times. The cortical response latencies were prolonged in tibial SEPs. CONCLUSIONS: The most prominent finding in this patient group was the low amplitude of CMAPs elicited in motor NCV studies which was concluded to be resulted from the reversible muscular changes. The other electrophysiological findings suggested that peripheral nerves and long central nervous system pathways were also mildly involved.     

Motor, sensory electroneurographic and electromyographic results as well as somatosensory evoked potentials in comparison to clinical findings following nerve suture

A group of 37 patients (total 41 nerves) with a traumatic transection of median or ulnar nerves at the wrist were reinvestigated clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. Clinically there was no relation between the time after the operation, and sensory recovery determined according to the schedule of Nicholson and Seddon (1957), two-point discrimination, vibration threshold. There was also no relationship between the time after suture, and the motor latencies as well as amplitudes of evoked muscle action potentials from the abductor pollicis brevis or hypothenar muscles. In sensory nerve fibres there was a statistically significant increase of the maximum amplitude and of the cumulative amplitude during the period after operation, due to an increasing number of regenerated nerve fibres. Sensory nerve conduction velocities showed no relation to the time after suture. Cumulative amplitudes were significantly related to two-point discrimination and to restitution of sensibility. As indicated by the great scatter, however, this parameter is merely a moderate predictor for the degree of clinical recovery. Somatosensory evoked potentials can be helpful in some cases to indicate nerve regeneration when nerve action potentials in peripheral nerves cannot be recorded. However, latencies and amplitudes of the individual peaks did not reveal any relationship to either clinical findings or to period of time after operation. Needle electromyography also yielded highly variable findings. A constant finding was a persistent loss of motor units. Most of these were increased sin size, as indicated by prolonged duration of their action potentials during slight voluntary effort.     

Analysis of motor conduction velocity in the human median nerve by computer simulation of compound muscle action potentials.

A digital computer was used to reconstruct compound muscle action potentials recorded from the human thenar eminence after stimulation of the median nerve. The programme allowed the following parameters to be varied: (1) the dimensions of a representative single motor unit potential; (2) the number of motor units in the muscle and the range and distribution of conduction velocities in their nerve fibres; and (3) the distance along the nerve from the point of stimulation to the muscle. The reconstructed compound muscle action potentials were similar to real compound potentials recorded from normal subjects. The number of single motor units and the range of conduction velocities required for the reconstruction correlated with quantitative histologic studies of the recurrent branch of the median nerve to the thenar muscles. By altering the distribution of conduction velocities it was possible to study the effect of abnormal patterns of nerve conduction on the configuration of the simulated compound muscle action potentials. It was found that abnormally slow conduction caused an increased discrepancy between the main parameters of compound potentials corresponding to stimulation of the nerve at proximal and distal sites. These observations suggest that a careful analysis of the differences between pairs of compound muscle action potentials may provide a method for more detailed assessment of conduction velocity in clinical studies of peripheral nerve disorders.     

Evaluation of the evoked potentials in various acquired polyneuropathies (Guillain-Barré syndrome and chronic recurrent polyneuropathy). Preliminary report

In 15 patients with acquired polyneuropathy (Guillain-Barré syndrome and chronic recurrent polyneuropathy) the conduction velocity was measured in the peripheral nerves of the upper and lower extremities, the latency of the F wave was determined, and the somatosensory evoked potentials were assessed stimulating the median enerve and posterior tibial nerve. The abnormalities were assessed in the parameters of the obtained somatosensory evoked potentials comparing them with the changes of F wave and the velocity of conduction in peripheral nerves. The sensitivity and usefulness of these methods in acquired polyneuropathies are discussed.     

Conduction in unmyelinated fibres in experimental neuropathy

Conduction velocity of autonomic unmyelinated fibres has been measured in the cervical sympathetic trunk of normal rats, and in rats intoxicated by acrylamide or by isoniazid. The mean maximal conduction velocity in nerves from normal rats is 2·0 m/sec. There is no significant reduction in velocity of the unmyelinated fibres in nerves from intoxicated rats, although histological studies of the sural nerve confirmed severe degeneration of myelinated fibres in the same animals. It is shown that the amplitude of the compound nerve action potential is proportional to the resistance between the recording electrodes. If this is taken into account, there is no reduction in the amplitude of the monophasic action potential of unmyelinated fibres recorded from the cervical sympathetic trunk of intoxicated rats. The amplitude of the A component of the sural nerve compound action potential is markedly reduced in rats intoxicated by acrylamide or by isoniazid, but there is no significant reduction in the amplitude of the C component in the same nerve. It is concluded that in the rat an insignificant number of unmyelinated fibres of autonomic or dorsal root origin are affected in the neuropathy produced by acrylamide or isoniazid. The relevance of these findings to human neuropathies is discussed.