A Test to Determine the Site of Abnormal Neuromuscular Refractoriness

Overview

Journal Clin Neurophysiol Pract

Publisher Elsevier

Specialty Neurology

Date 2022 Jan 5

PMID 34984248

Citations 2

Authors

Hatice Tankisi

Hugh Bostock

Peter Grafe

Affiliations

Soon will be listed here.

Abstract

Objective: The relative refractory period (RRP) of motor axons is an important parameter in nerve excitability tests of the recovery cycle (RC). Abnormalities may have a site in the axonal membrane, the neuromuscular junction, or in a dysfunction of the muscle. We aimed in this study to determine the site of abnormality, using a modified protocol of the conventional RC test, whereby an additional supramaximal stimulus is added at the same interstimulus interval as in RC recordings (RCSM).

Methods: Twenty-four healthy subjects aged 37.8 ± 2.4 years (mean ± SE) were examined with median nerve excitability testing using RC and RCSM protocols at normal temperature (34.1 ± 0.2 °C). The recordings were repeated in 12 subjects after selective cooling of the thenar muscle (25.2 ± 0.7 °C) and in 12 subjects after cooling the nerve trunk at the wrist (24.9 ± 0.3 °C).

Results: After cooling the nerve, RRP measured with RC and RCSM were prolonged similarly (medians by 1.8 ms, and 2.1 ms respectively). In contrast, cooling the muscle prolonged RRP measured with RC (by 1.3 ms), but did not significantly prolong RRP measured with RCSM. RRPs measured by RC and RCSM were significantly different when cooling was at the muscle (P = 5.10), but not when cooling was at the nerve (P = 0.57).

Conclusions: A difference between RC and RCSM indicates abnormal excitability distal to the axonal membrane under the stimulating electrode.

Significance: Combining RCSM with the conventional RC protocol should help to localize the site of abnormal neuromuscular refractoriness.

Citing Articles

Revisiting distinct nerve excitability patterns in patients with amyotrophic lateral sclerosis.

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PMID: 38662766 PMC: 11491535. DOI: 10.1093/brain/awae131.

The test-retest reliability of large and small fiber nerve excitability testing with threshold tracking.

Pia H, Nochi Z, Kristensen A, Pelz B, Goetz M, Hoeink J Clin Neurophysiol Pract. 2023; 8:71-78.

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References

Kiernan M, Bostock H . Effects of membrane polarization and ischaemia on the excitability properties of human motor axons. Brain. 2000; 123 Pt 12:2542-51. DOI: 10.1093/brain/123.12.2542. View

Kiernan M, Bostock H, Park S, Kaji R, Krarup C, Krishnan A . Measurement of axonal excitability: Consensus guidelines. Clin Neurophysiol. 2019; 131(1):308-323. DOI: 10.1016/j.clinph.2019.07.023. View

Heide R, Bostock H, Ventzel L, Grafe P, Bergmans J, Fuglsang-Frederiksen A . Axonal excitability changes and acute symptoms of oxaliplatin treatment: In vivo evidence for slowed sodium channel inactivation. Clin Neurophysiol. 2017; 129(3):694-706. DOI: 10.1016/j.clinph.2017.11.015. View

Tomlinson S, Tan S, Kullmann D, Griggs R, Burke D, Hanna M . Nerve excitability studies characterize Kv1.1 fast potassium channel dysfunction in patients with episodic ataxia type 1. Brain. 2010; 133(Pt 12):3530-40. PMC: 2995887. DOI: 10.1093/brain/awq318. View

Bennedsgaard K, Ventzel L, Grafe P, Tigerholm J, Themistocleous A, Bennett D . Cold aggravates abnormal excitability of motor axons in oxaliplatin-treated patients. Muscle Nerve. 2020; 61(6):796-800. PMC: 7318596. DOI: 10.1002/mus.26852. View

Kiernan M, Cikurel K, Bostock H . Effects of temperature on the excitability properties of human motor axons. Brain. 2001; 124(Pt 4):816-25. DOI: 10.1093/brain/124.4.816. View

Lee J, Boland-Freitas R, Liang C, Howells J, Ng K . Neuropathy in sporadic inclusion body myositis: A multi-modality neurophysiological study. Clin Neurophysiol. 2020; 131(11):2766-2776. DOI: 10.1016/j.clinph.2020.07.025. View

Kuwabara S, Bostock H, Ogawara K, Sung J, Kanai K, Mori M . The refractory period of transmission is impaired in axonal Guillain-Barré syndrome. Muscle Nerve. 2003; 28(6):683-9. DOI: 10.1002/mus.10488. View

Krishnan A, Phoon R, Pussell B, Charlesworth J, Bostock H, Kiernan M . Altered motor nerve excitability in end-stage kidney disease. Brain. 2005; 128(Pt 9):2164-74. DOI: 10.1093/brain/awh558. View

10.

Stalberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M . Standards for quantification of EMG and neurography. Clin Neurophysiol. 2019; 130(9):1688-1729. DOI: 10.1016/j.clinph.2019.05.008. View

11.

ZGraggen W, Lin C, Howard R, Beale R, Bostock H . Nerve excitability changes in critical illness polyneuropathy. Brain. 2006; 129(Pt 9):2461-70. DOI: 10.1093/brain/awl191. View

12.

Boerio D, Hogrel J, Creange A, Lefaucheur J . [Methods and clinical value of peripheral nerve refractory period measurement in man]. Neurophysiol Clin. 2005; 34(6):279-91. DOI: 10.1016/j.neucli.2004.08.002. View

13.

Franssen H, Gebbink T, Wokke J, van den Berg L, van Schelven L . Is cold paresis related to axonal depolarization?. J Peripher Nerv Syst. 2010; 15(3):227-37. DOI: 10.1111/j.1529-8027.2010.00275.x. View

14.

Boerio D, Hogrel J, Bassez G, Lefaucheur J . Neuromuscular excitability properties in myotonic dystrophy type 1. Clin Neurophysiol. 2007; 118(11):2375-82. DOI: 10.1016/j.clinph.2007.07.018. View

15.

Park S, Lin C, Krishnan A, Goldstein D, Friedlander M, Kiernan M . Dose effects of oxaliplatin on persistent and transient Na+ conductances and the development of neurotoxicity. PLoS One. 2011; 6(4):e18469. PMC: 3072981. DOI: 10.1371/journal.pone.0018469. View

16.

Kovalchuk M, Franssen H, van den Berg L, van Schelven L, Sleutjes B . Excitability of motor and sensory axons in multifocal motor neuropathy. Clin Neurophysiol. 2020; 131(11):2641-2650. DOI: 10.1016/j.clinph.2020.08.004. View

17.

Boerio D, Hogrel J, Creange A, Lefaucheur J . A reappraisal of various methods for measuring motor nerve refractory period in humans. Clin Neurophysiol. 2005; 116(4):969-76. DOI: 10.1016/j.clinph.2004.11.018. View