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Threshold Stimulation for Nerve Conduction Studies in Man

Threshold Stimulation for Nerve Conduction Studies in Man Abstract The TECHNIQUE of determining motor conduction velocities in human nerves is now extensively used in the investigation of neuromuscular disorders. The standard method requires a supramaximal stimulus for motor fibers in order to obtain a reproducible conduction time which is as short as possible. This method, therefore, measures the conduction velocity in only the fastest motor fibers and gives no information concerning slower conducting fibers. Although this technique is helpful is diagnosing peripheral nerve dysfunction even in patients without signs and symptoms, there are some patients who have peripheral nerve symptoms without a reduction in the speed of motor nerve conduction.1-5 It is known from studies in experimental animals that the speed of conduction determined in whole nerve trunks need not represent the rate in the fastest single fibers due to shunting and dispersion of the activity in these few large fibers.6 Therefore, additional techniques have been References 1. Lambert, E.H.: Neurophysiological Techniques Useful in the Study of Neuromuscular Disorders , Assoc Res Nerv Dis Proc 38:247-273, 1958. 2. Mulder, D.W.; Lambert, E.H.; and Sprague, R.G.: The Neuropathies Associated With Diabetes Mellitus , Neurology 11:275-284, 1961. 3. Mayer, R.F.: Nerve Conduction Studies in Man , Neurology 13:1021-1030, 1963.Crossref 4. Mawdsley, C., and Mayer, R.F.: Nerve Conduction in Alcoholic Polyneuropathy , Brain 88:335-356, 1965.Crossref 5. Thomas, P.K.: Motor Nerve Conduction in Carpal Tunnel Syndrome , Neurology 10:1045-1050, 1960.Crossref 6. McDonald, W.I.: The Effects of Experimental Demyelination on Conduction in Peripheral Nerve: A Histological Electrophysiological Study: II. Electrophysiological Observations , Brain 86:501-524, 1963.Crossref 7. Dawson, G.D.: The Relative Excitability and Conduction Velocity of Sensory and Motor Nerve Fibers in Man , J Physiol 131:451-463, 1956. 8. Thomas, P.K.; Sears, T.A.; and Gilliatt, R.W.: Range of Conduction Velocity in Normal Nerve Fibers to Small Muscles of Hand and Foot , J Neurol Neurosurg Psychiat 22:175-181, 1959.Crossref 9. Hopf, H.C.: Electromyographic Study on So-Called Mononeuritis , Arch Neurol 9:307-312, 1963.Crossref 10. Preswick, G.: The Effect of Stimulus Intensity on Motor Latency in the Carpal Tunnel Syndrome , J Neurol Neurosurg Psychiat 26:398-401, 1963.Crossref 11. Podivinsky, F.: The Effect of Stimulus In tensity on Latency of Nerve Action Potential in Healthy Subjects and in Patients With Peripheral Nerve Lesions , Neurology 15:1059-1062, 1965.Crossref 12. Tasaki, I.; Ishii, K.; and Ito, H.: On the Relation Between the Conduction-Rate, the Fibre-Diameter and the Internodal Distance of the Medullated Nerve Fibre , Jap J Med Sci III Biophysics 9:189-199, 1944. 13. Gassel, M.M.; Sources of Error in Motor Nerve Conduction Studies , Neurology 14:825-835, 1964.Crossref 14. Hodes, R., et al: Low Threshold Associated With Slow Conduction Velocity , Arch Neurol 12:510-526, 1965.Crossref 15. Sunderland, S.: The Intraneural Topography of the Radial, Median and Ulnar Nerves , Brain 68:243-299, 1945.Crossref 16. Sunderland, S.: The Connective Tissues of Peripheral Nerves , Brain 88:841-854, 1965.Crossref 17. Buchthal, F.; Guld, C.; and Rosenfalk, P.: Innervation Zone and Propagation Velocity in Human Muscle , Acta Physiol Scand 35:174-190, 1955.Crossref 18. Eccles, J.C., and Sherrington, C.S.: Numbers and Contraction-Values of Individual Motor Units Examined in Some Muscles of the Limb , Proc Roy Soc 106:326-357, 1930.Crossref 19. McPhedron, A.M.; Wuerker, R.B.; and Henneman, E.: Properties of Motor Units in a Homogeneous Red Muscle (Soleus) of the Cat , J Neurophysiol 28:71-84, 1965. 20. Ranson, S.W., et al: Number, Size and Myelination of the Sensory Fibers in the Cerebrospinal Nerves , Assoc Res Nerv Dis Proc 15:3-34, 1934. 21. Hursh, J.B.: Conduction Velocity and Diameter of Nerve Fibers , Amer J Physiol 127:131-139, 1939. 22. Boyd, J.A.: The Relation Between Conduction Velocity and Diameter for the Three Groups of Efferent Fibers in Nerves to Mammalian Skeletal Muscle , J Physiol 175:33-35P, 1964. 23. Denny-Brown, D.: The Neurological Aspects of Thiamine Deficiency , Fed Proc 2( (suppl 17) ):35-39, 1958. 24. Mayer, R.F.: Peripheral Nerve Conduction in Alcoholics , J Psychosom Med , to be published, 1966. 25. Dawson, G.D., and Scott, J.W.: The Recording of Nerve Action Potentials Through Skin in Man , J Neurol Neurosurg Psychiat 12:259-267, 1949.Crossref 26. Gilliatt, R.W., et al: A Study of Normal Nerve Action Potentials Using an Averaging Technique (Barrier Grid Storage Tube) , J Neurol Neurosurg Psychiat 28:191-200, 1965.Crossref 27. Mayer, R.F.: Observations on Some Mechanisms of Altered Nerve Conduction in Man , Proc 8th Int Cong Neurol II:423-427, 1965. 28. Kaeser, H.E., and Lambert, E.H.: Nerve Function Studies in Experimental Polyneuritis , Electroenceph Clin Neurophysiol 22( (suppl) ):29-35, y. 29. Bannister, R.G., and Sears, T.A.: The Changes in Nerve Conduction in Acute Idiopathic Polyneuritis , J Neurol Neurosurg Psychiat 25:321-328, 1962.Crossref 30. Mayer, R.F.: Peripheral Nerve Function in Vitamin B12 Deficiency , Arch Neurol 13:355-362, 1965.Crossref 31. Mayer, R.F., and Denny-Brown, D.: Conduction Velocity in Peripheral Nerve During Experimental Demyelination in the Cat , Neurology 14:714-726, 1964.Crossref 32. Collins, G.H.; Webster, H.DeF.; and Victor, M.: The Ultrastructure of Myelin and Axonal Alterations in Sciatic Nerves of Thiamine Deficient and Chronically Starved Rats , Acta Neuropath 3:511-521, 1964.Crossref 33. Berry, C.M.; Grundfest, H.; and Hinsey, J.C.: The Electrical Activity of Regenerating Nerves in the Cat , J Neurophysiol 7:103-115, 1944. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Threshold Stimulation for Nerve Conduction Studies in Man

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1966.00470160076011
Publisher site
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Abstract

Abstract The TECHNIQUE of determining motor conduction velocities in human nerves is now extensively used in the investigation of neuromuscular disorders. The standard method requires a supramaximal stimulus for motor fibers in order to obtain a reproducible conduction time which is as short as possible. This method, therefore, measures the conduction velocity in only the fastest motor fibers and gives no information concerning slower conducting fibers. Although this technique is helpful is diagnosing peripheral nerve dysfunction even in patients without signs and symptoms, there are some patients who have peripheral nerve symptoms without a reduction in the speed of motor nerve conduction.1-5 It is known from studies in experimental animals that the speed of conduction determined in whole nerve trunks need not represent the rate in the fastest single fibers due to shunting and dispersion of the activity in these few large fibers.6 Therefore, additional techniques have been References 1. Lambert, E.H.: Neurophysiological Techniques Useful in the Study of Neuromuscular Disorders , Assoc Res Nerv Dis Proc 38:247-273, 1958. 2. Mulder, D.W.; Lambert, E.H.; and Sprague, R.G.: The Neuropathies Associated With Diabetes Mellitus , Neurology 11:275-284, 1961. 3. Mayer, R.F.: Nerve Conduction Studies in Man , Neurology 13:1021-1030, 1963.Crossref 4. Mawdsley, C., and Mayer, R.F.: Nerve Conduction in Alcoholic Polyneuropathy , Brain 88:335-356, 1965.Crossref 5. Thomas, P.K.: Motor Nerve Conduction in Carpal Tunnel Syndrome , Neurology 10:1045-1050, 1960.Crossref 6. McDonald, W.I.: The Effects of Experimental Demyelination on Conduction in Peripheral Nerve: A Histological Electrophysiological Study: II. Electrophysiological Observations , Brain 86:501-524, 1963.Crossref 7. Dawson, G.D.: The Relative Excitability and Conduction Velocity of Sensory and Motor Nerve Fibers in Man , J Physiol 131:451-463, 1956. 8. Thomas, P.K.; Sears, T.A.; and Gilliatt, R.W.: Range of Conduction Velocity in Normal Nerve Fibers to Small Muscles of Hand and Foot , J Neurol Neurosurg Psychiat 22:175-181, 1959.Crossref 9. Hopf, H.C.: Electromyographic Study on So-Called Mononeuritis , Arch Neurol 9:307-312, 1963.Crossref 10. Preswick, G.: The Effect of Stimulus Intensity on Motor Latency in the Carpal Tunnel Syndrome , J Neurol Neurosurg Psychiat 26:398-401, 1963.Crossref 11. Podivinsky, F.: The Effect of Stimulus In tensity on Latency of Nerve Action Potential in Healthy Subjects and in Patients With Peripheral Nerve Lesions , Neurology 15:1059-1062, 1965.Crossref 12. Tasaki, I.; Ishii, K.; and Ito, H.: On the Relation Between the Conduction-Rate, the Fibre-Diameter and the Internodal Distance of the Medullated Nerve Fibre , Jap J Med Sci III Biophysics 9:189-199, 1944. 13. Gassel, M.M.; Sources of Error in Motor Nerve Conduction Studies , Neurology 14:825-835, 1964.Crossref 14. Hodes, R., et al: Low Threshold Associated With Slow Conduction Velocity , Arch Neurol 12:510-526, 1965.Crossref 15. Sunderland, S.: The Intraneural Topography of the Radial, Median and Ulnar Nerves , Brain 68:243-299, 1945.Crossref 16. Sunderland, S.: The Connective Tissues of Peripheral Nerves , Brain 88:841-854, 1965.Crossref 17. Buchthal, F.; Guld, C.; and Rosenfalk, P.: Innervation Zone and Propagation Velocity in Human Muscle , Acta Physiol Scand 35:174-190, 1955.Crossref 18. Eccles, J.C., and Sherrington, C.S.: Numbers and Contraction-Values of Individual Motor Units Examined in Some Muscles of the Limb , Proc Roy Soc 106:326-357, 1930.Crossref 19. McPhedron, A.M.; Wuerker, R.B.; and Henneman, E.: Properties of Motor Units in a Homogeneous Red Muscle (Soleus) of the Cat , J Neurophysiol 28:71-84, 1965. 20. Ranson, S.W., et al: Number, Size and Myelination of the Sensory Fibers in the Cerebrospinal Nerves , Assoc Res Nerv Dis Proc 15:3-34, 1934. 21. Hursh, J.B.: Conduction Velocity and Diameter of Nerve Fibers , Amer J Physiol 127:131-139, 1939. 22. Boyd, J.A.: The Relation Between Conduction Velocity and Diameter for the Three Groups of Efferent Fibers in Nerves to Mammalian Skeletal Muscle , J Physiol 175:33-35P, 1964. 23. Denny-Brown, D.: The Neurological Aspects of Thiamine Deficiency , Fed Proc 2( (suppl 17) ):35-39, 1958. 24. Mayer, R.F.: Peripheral Nerve Conduction in Alcoholics , J Psychosom Med , to be published, 1966. 25. Dawson, G.D., and Scott, J.W.: The Recording of Nerve Action Potentials Through Skin in Man , J Neurol Neurosurg Psychiat 12:259-267, 1949.Crossref 26. Gilliatt, R.W., et al: A Study of Normal Nerve Action Potentials Using an Averaging Technique (Barrier Grid Storage Tube) , J Neurol Neurosurg Psychiat 28:191-200, 1965.Crossref 27. Mayer, R.F.: Observations on Some Mechanisms of Altered Nerve Conduction in Man , Proc 8th Int Cong Neurol II:423-427, 1965. 28. Kaeser, H.E., and Lambert, E.H.: Nerve Function Studies in Experimental Polyneuritis , Electroenceph Clin Neurophysiol 22( (suppl) ):29-35, y. 29. Bannister, R.G., and Sears, T.A.: The Changes in Nerve Conduction in Acute Idiopathic Polyneuritis , J Neurol Neurosurg Psychiat 25:321-328, 1962.Crossref 30. Mayer, R.F.: Peripheral Nerve Function in Vitamin B12 Deficiency , Arch Neurol 13:355-362, 1965.Crossref 31. Mayer, R.F., and Denny-Brown, D.: Conduction Velocity in Peripheral Nerve During Experimental Demyelination in the Cat , Neurology 14:714-726, 1964.Crossref 32. Collins, G.H.; Webster, H.DeF.; and Victor, M.: The Ultrastructure of Myelin and Axonal Alterations in Sciatic Nerves of Thiamine Deficient and Chronically Starved Rats , Acta Neuropath 3:511-521, 1964.Crossref 33. Berry, C.M.; Grundfest, H.; and Hinsey, J.C.: The Electrical Activity of Regenerating Nerves in the Cat , J Neurophysiol 7:103-115, 1944.

Journal

Archives of NeurologyAmerican Medical Association

Published: Oct 1, 1966

References