Deriving reference values for nerve conduction studies from existing data using mixture model clustering

Reijntjes, R.; Potters, Wouter V.; Kerkhof, Fabian I.; Zwet, Erik W. van; Rossum, Ineke A. van; Verhamme, Camiel; Tannemaat, Martijn R.

doi:10.1016/j.clinph.2021.04.013

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…Obtaining reference values has been a challenge, and published reports yielded only one study of sufficient quality, according to a recent systematic review 1 . Therefore, attempts have been made to estimate reference values by various statistical models 24,25 …”

Section: Discussionmentioning

confidence: 99%

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Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population‐based cohort: Associations with demographic and anthropometric characteristics—The Maastricht study

Hodzelmans,

Janssen,

Reulen

et al. 2024

Muscle and Nerve

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Introduction/AimsNerve conduction studies (NCSs) are widely used to support the clinical diagnosis of neuromuscular disorders. The aims of this study were to obtain reference values for peroneal, tibial, and sural NCSs and to examine the associations with demographic and anthropometric factors.MethodsIn 5099 participants (aged 40–79 years) without type 2 diabetes of The Maastricht Study, NCSs of peroneal, tibial, and sural nerves were performed. Values for compound muscle action potential (CMAP) and sensory nerve action potential amplitude, nerve conduction velocity (NCV), and distal latency were acquired. The association of age, sex, body mass index (BMI), and height with NCS values was determined using uni‐ and multivariate linear regression analyses.ResultsDetailed reference values are reported per decade for men and women. Significantly lower NCVs and longer distal latencies were observed in all nerves in older and taller individuals as well as in men. In these groups, amplitudes of the tibial and sural nerves were significantly lower, whereas a lower peroneal nerve CMAP was only significantly associated with age. BMI showed a multidirectional association. After correction for anthropometric factors in the multivariate analysis, the association between sex and NCS values was less straightforward.DiscussionThese values from a population‐based dataset could be used as a reference for generating normative values. Our findings show the association of NCS values with anthropometric factors. In clinical practice, these factors can be considered when interpreting NCS values.

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Section: Discussionmentioning

confidence: 99%

“…1 Therefore, attempts have been made to estimate reference values by various statistical models. 24,25 Our study meets most criteria described by the NDTF to evaluate studies for normative standard. Several limitations remain.…”

Section: Limitationsmentioning

confidence: 99%

Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population‐based cohort: Associations with demographic and anthropometric characteristics—The Maastricht study

Hodzelmans,

Janssen,

Reulen

et al. 2024

Muscle and Nerve

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“…This corresponds to previous research showing lower N1P1 oVEMP amplitudes in older adults 10 and lower CMAP amplitudes in a healthy older adults. 17 Unfortunately, these findings might reduce the clinical utility of the ROVEMP. The average age at onset of MG is 44 years, 18 and because the subjective quality of the ROVEMP signal and objective measures such as the N2P2 amplitude decline with age, the quality of a measurement must be taken into account for older patients in clinical practice because diagnostic yield seems to be low in subjects older than 55 years.…”

Section: Discussionmentioning

confidence: 99%

Test–Retest Reliability of Repetitive Ocular Vestibular Evoked Myogenic Potentials in Myasthenia Gravis Patients and Healthy Control Subjects

Keene

Bongers

Meel

et al. 2022

Journal of Clinical Neurophysiology

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Purpose: Repetitive ocular vestibular evoked myogenic potentials (ROVEMP) are a novel diagnostic test to quantify neuromuscular transmission deficits in extraocular muscles in myasthenia gravis. We aimed to investigate the test-retest reliability of the ROVEMP and the effect of amplitude and age.Methods: We performed the ROVEMP test twice in 19 patients with myasthenia gravis (52.7 6 19.8 years) and in 15 healthy control subjects (46.5 6 16 years). The Bland-Altman level of agreement was determined. The relationship between testretest reliability and signal quality, participant age and signal amplitude was studied.Results: Limits of agreement were from 2179.9 to 139.3 in myasthenia gravis patients and from 256.9 to 89.5 in healthy control subjects. Difference between measurements correlated with signal amplitude (r ¼ 20.50, P , 0.001). Combining the primary cohort with previously published data from 114 subjects, we found a significant negative correlation between age and reference amplitude (r ¼ 20.163, P ¼ 0.045). Conclusions:This study shows that in our hands, the test-retest reliability of the ROVEMP is not optimal. Measurements with higher reference amplitude had a better quality, higher reproducibility, and increased diagnostic yield. We caution against the use of ROVEMP measurements of lower amplitude in clinical practice. In addition, given the correlation between age and amplitude, age matching of healthy control subjects and patients is essential in future studies.

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“…The lack of sufficient data about the reference value of nerve conduction study and the debate on the interpretation of results is worldwide in the literature until now. Considerable debate remains about using RVs available in the literature and RVs collected in individual clinical neurophysiology departments [ 11 ]. Publicly available RVs for NCS are rare; a recent systematic review only found one set of RVs of sufficient quality for a small number of measurements [ 12 ].…”

mentioning

confidence: 99%

“…Such a statistical approach is not uncommon. In a study, R. H. Reijntjes and his colleagues [ 11 ] developed a mixture module to diagnose abnormality in nerve conduction study and concluded that ± 2 SD of normal is the proper diagnosis of abnormality.…”

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confidence: 99%

Response to editor’s letter

Shaddad

2023

Egypt J Bronchol

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Deriving reference values for nerve conduction studies from existing data using mixture model clustering

Cited by 10 publications

References 24 publications

Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population‐based cohort: Associations with demographic and anthropometric characteristics—The Maastricht study

Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population‐based cohort: Associations with demographic and anthropometric characteristics—The Maastricht study

Test–Retest Reliability of Repetitive Ocular Vestibular Evoked Myogenic Potentials in Myasthenia Gravis Patients and Healthy Control Subjects

Response to editor’s letter

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