Double peak sensory nerve action potentials to single stimuli in nerve conduction studies

Leote, João; Pereira, Pedro; Valls‐Solé, Josep

doi:10.1002/mus.25486

Cited by 4 publications

(7 citation statements)

References 58 publications

(152 reference statements)

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“…The significant and consistent finding of reversed pre-pulse effects in bipolar setup due to excitation at the return electrode not only helps to resolve two decades of conflicting data in the published literature on pre-pulses, but also stresses the strong influence of electrode configuration on the effect of variations in pulse shape. While the generation of action potentials at the return electrode of a bipolar electrode pair is the subject of recent research in the field of clinical nerve conduction studies [16], it has not yet Fig. 6.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Sub-Threshold Pre-Pulses on Neural Activation Depends on Electrode Configuration

Eickhoff

Jarvis

2020

IEEE Trans. Biomed. Eng.

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Objective: Published research on nerve stimulation with sub-threshold conditioning pre-pulses is contradictory. Like most early research on electrical stimulation (ES), the pioneer work on the use of pre-pulses was modelled and measured only for monopolar electrodes. However, many contemporary ES applications, including miniaturized neuromodulation implants, known as electroceuticals, operate in bipolar mode. Methods: We compared depolarizing (DPPs) and hyperpolarizing (HPPs) prepulses on neural excitability in rat nerve with monopolar and bipolar electrodes. The rat common peroneal nerve was stimulated with biphasic stimuli with and without ramp and square DPPs or HPPs of 1, 5 and 10ms duration and 10% -20% of the amplitude of the following pulse. Results: The effects were opposite for the monopolar and bipolar configurations. With monopolar electrodes DPPs increased the amplitude required to activate 50% of the motoneuron pool (between 0.7% and 10.3%) and HPPs decreased the threshold (between 1.7% and 4.7%). With bipolar electrodes both pre-pulse types had the opposite effect: DPPs decreased thresholds (between 1.8% and 5.5%) whereas HPPs increased thresholds (between 0.5% and 4.1%). Electroneurograms from the stimulated nerve revealed spatial and temporal differences in action potential generation for monopolar and bipolar electrodes. In bipolar biphasic stimulation, excitation first occurred at the return electrode as a response to the transition between the cathodic and anodic phase. Conclusion: These data help to resolve the contradictions in the published data over two decades. Significance: They also show that fundamental research carried out in monopolar configuration is not directly applicable to contemporary bipolar ES applications.

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Section: Discussionmentioning

confidence: 99%

The Effect of Sub-Threshold Pre-Pulses on Neural Activation Depends on Electrode Configuration

Eickhoff

Jarvis

2020

IEEE Trans. Biomed. Eng.

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“…It is recognized that trial‐to‐trial, a reflex is physiologically conducted by different sensory and motor axon fibers with varying conduction velocities, which may contribute to latency variability during LAR‐C‐IONM. In addition, slight movements of the endotracheal tube relative to the mucosa during surgical tissue manipulation may intermittently favor cathodic or anodic axonal depolarization, thereby increasing LAR latency variability …”

Section: Discussionmentioning

confidence: 99%

“…In addition, slight movements of the endotracheal tube relative to the mucosa during surgical tissue manipulation may intermittently favor cathodic or anodic axonal depolarization, thereby increasing LAR latency variability. 21…”

Section: Discussionmentioning

confidence: 99%

Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk

Sinclair¹,

Téllez

Ulkatan

2018

Head & Neck

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“…Nos estudos de condução nervosa, o PAS-D registado após um único estímulo pode ocorrer em algumas situações já reportadas na literatura 12 . Contudo, não é conhecida a sua frequência em sujeitos saudáveis.…”

Section: Lista De Acrónimosunclassified

“…A ecografia de alta resolução (9-15Mhz; ultrassonografia) de nervo permite detetar lesões que diminuam o espaço e a mobilidade no percurso anatómico do nervo 12 . Adicionalmente, pode ser detetado edema perineural no STC, consequente da compressão, sendo uma ferramenta auxiliar de diagnóstico 13 Ambos os grupos foram submetidos a uma avaliação eletrofisiológica e ecográfica.…”

Section: Lista De Acrónimosunclassified

Potencial de ação duplo e alterações ecográficas do nervo mediano em doentes com síndrome do túnel cárpico

Teixeira

Leote

2019

Clin. Biomed. Res.

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Introdução: A síndrome do túnel cárpico (STC) é sustentada pela presença de lentificação do potencial de ação do nervo mediano no estudo ortodrómico de condução nervosa sensitiva em comparação com o nervo radial (EC-MR). Uma técnica modificada de registo simultâneo de ambos os nervos (EC-MRsimul) pode ser utilizada, detetando a lentificação do nervo mediano através da presença de potencial de ação sensitivo duplo (PAS-D). O objetivo deste estudo é correlacionar o PAS-D com os achados de EC-MR e com o edema perineural em doentes com diagnóstico de STC. Métodos: Indivíduos saudáveis e doentes com STC há menos de 12 meses foram submetidos a avaliação eletrofisiológica, incluindo o EC-MR e o EC-MRsimul. Foi também realizada ultrassonografia para registo da área seccional do nervo mediano (AS-NM) no punho e antebraço e, respetivo índice punho-antebraço (I-PA). Resultados: Foram recrutados 38 doentes com idade média de 54,8 ± 15,3 anos com STC e 18 indivíduos saudáveis. A diferença de latência distal entre o nervo mediano e radial foi superior nos doentes (0,80 ± 0,30ms vs. 0,15 ± 0,20ms; p=0,015). O EC-MRsimul demonstrou a presença de PAS-D nos indivíduos sintomáticos. A AS-NM no punho foi também superior nos doentes (8,9 ± 0,9mm2 vs. 6,6 ± 0,7mm2; p<0.003), tendo sido identificado um quisto sinovial e um neurinoma. O edema perineural traduzido pela AS-SM correlacionou-se positivamente com a diferença de latência interpico no EC-MR e com a presença de PAS-D. Conclusão: O PAS-D está associado à presença de lentificação da condução e ao edema perineural do nervo mediano no contexto de STC ou devido a lesões ocupantes de espaço.

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Double peak sensory nerve action potentials to single stimuli in nerve conduction studies

Abstract: Although the recording of DPps is not a standardized neurophysiological method, their study brings interesting cues about the physiology of nerve stimulation and paves the way for clinical application of such an observation. Muscle Nerve 55: 619-625, 2017.

Cited by 4 publications

References 58 publications

The Effect of Sub-Threshold Pre-Pulses on Neural Activation Depends on Electrode Configuration

The Effect of Sub-Threshold Pre-Pulses on Neural Activation Depends on Electrode Configuration

Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk

Potencial de ação duplo e alterações ecográficas do nervo mediano em doentes com síndrome do túnel cárpico

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