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. 2022 Jan 7:7:27-33.
doi: 10.1016/j.cnp.2021.12.001. eCollection 2022.

The additional diagnostic value of motor nerve excitability testing in chronic axonal neuropathy

Thomas Krøigård  1   2   3 , Ulrik Sodemann  1 , Laura M Gaist  1   2   3 , Søren H Sindrup  1   2   3 , Hatice Tankisi  4
Affiliations

The additional diagnostic value of motor nerve excitability testing in chronic axonal neuropathy

Thomas Krøigård et al. Clin Neurophysiol Pract. .

Abstract

Objective: To explore potential differences in motor nerve excitability testing (NET) variables at group levels between patients with a clinical diagnosis of polyneuropathy (PNP), which did not fulfil diagnostic criteria of conventional nerve conduction studies (NCS) and patients without polyneuropathy. Such differences could support a role for NET in increasing the diagnostic sensitivity of NCS in chronic axonal PNP.

Methods: Motor NET was performed using the median nerve in patients with a clinical suspicion of PNP in addition to conventional NCS, skin biopsies, corneal confocal microscopy and structured clinical evaluation including scoring of neuropathy symptoms and signs.

Results: Of the 57 patients included, 32 had PNP, half of which had NCS, which fulfilled criteria for PNP (NCS+ PNP). There were no significant differences for any of the NET variables between PNP patients with non-diagnostic conventional NCS (NCS- PNP) and patients without PNP. Rheobase was increased, and Ted (undershoot) and subexcitability were decreased in NCS+ PNP. Sural amplitude, peroneal nerve F-wave latency and tibial nerve F-wave-latency were correlated with subexcitability, and tibial nerve motor amplitude was correlated with rheobase.

Conclusions: NET was correlated with conventional NCS and no differences were found between NCS- PNP patients and patients without PNP.

Significance: NET does not seem to offer any additional diagnostic value in chronic mixed etiology neuropathy.

Keywords: Diagnosis; Nerve conduction studies; Nerve excitability testing; Polyneuropathy.

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Figures

Fig. 1
Fig. 1
Motor nerve excitability measures including A: current-threshold relationship, B: strength-duration properties, C: threshold electrotonus, and D recovery cycle. Red: NCS+ PNP, green: NCS− PNP, blue: No polyneuropathy. Data shown as mean ± SD. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Correlations between NET and conventional NCS. Sural nerve amplitude and subexcitability (r = 0.6309; p = 0.018), tibial nerve motor amplitude and rheobase (r = −0.4139; p = 0.044), peroneal nerve F-wave latency and subexcitability (r = −0.5525; p = 0.010) and tibial nerve F-wave-latency and subexcitability (r = −0.5408; p = 0.004) were significantly correlated.
Fig. 3
Fig. 3
Correlations between NET and clinical neuropathy scores and vibration detection threshold (VDT). Correlations were not statistically significant.
See this image and copyright information in PMC

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