Recurrent potentials in human peripheral sensory nerve: possible evidence of primary afferent depolarization of the spinal cord.

To study slowly conducted components of the orthodromic compound sensory action potential (CSAP), the response evoked at the lateral malleolus in the sural nerve was recorded through near-nerve needles at two to four sites along the nerve at midcalf. When 500 to 2000 responses were averaged at high gain, components with latencies of 30 to 80 ms were often recorded. In contrast to the main component and late components with latencies of less than 15 to 20 ms, the latencies of these extremely late components diminished the closer to the spinal cord that they were recorded.

Case-of-the-month: autosomal recessive myotonia congenita: marked muscle weakness in a 16-year-old boy.

A 16-year-old boy had a 10-year history of stiffness in leg muscles. There was marked weakness of neck flexors, shoulder abductors, and ankle dorsiflexors, with hypertrophy of most muscle groups and both action and percussion myotonia. The parents were normal.

Slowly conducting myelinated fibers in peripheral neuropathy.

The main component of the compound sensory action potential reflects the activity of large myelinated sensory fibers with diameters of greater than 9 micron(s). By recording the averaged potential using a needle electrode placed close to the nerve, small late components can be measured. The latency of these late components can be used to calculate minimum conduction velocity (CV); in normal subjects, average minimum CV is 15 m/s, corresponding to conduction in fibers of about 4 micron(s) in diameter.

Schmidt-Lanterman clefts: a morphometric study in human sural nerve.

In the human sural nerve, large myelinated fibers contained 35 Schmidt-Lanterman (SL) clefts per mm, and small myelinated fibers contained only eight SL clefts per mm. The incidence of SL clefts is linearly related to myelin thickness. The SL clefts extended over 13 micron in large and over 9 micron in small fibers, the total extent of the SL region amounting to nearly 50% of internodal length in large and to 6% in small fibers.

Peripheral neuropathy in mitochondrial disease.

Clinical, electrophysiological, histological and biochemical studies of two patients with mitochondrial disease revealed a moderately advanced axonal neuropathy with mitochondrial paracrystalline inclusions in Schwann cells, fibroblasts and muscle fibers. In addition there was a myopathy, and the activity of muscle cytochrome c oxidase was diminished by more than 50%. There were electrophysiological signs of myopathy, neuropathy and failure of excitation-contraction coupling in both patients.

Peripheral neuropathy in abetalipoproteinemia.

We studied the peripheral neuropathy of three sisters with abetalipoproteinemia. Clinically, a sensory neuropathy progressively increased in severity. There was a diminution in the amplitude of sensory action potentials and a slight-to-moderate slowing in maximum sensory conduction velocity, initially most marked in distal portions of the nerves.

Electromyography in the evaluation of muscle diseases.

This review deals with electromyographic criteria that distinguish between weakness and wasting due to disease of the muscle fiber or secondary to denervation. The criteria reflect scattered loss or block of muscle fibers. The diagnostic yield of the electromyographic criteria is 87 per cent, slightly higher than the yield of histopathology and histochemistry.

Peripheral neuropathy in hypereosinophilic syndrome.

We evaluated seven patients with the hypereosinophilic syndrome (HES) to define the clinicopathologic spectrum of the peripheral neuropathy. Clinically, three had evident polyneuropathy; the others were asymptomatic, although they had electrophysiologic evidence of neuropathy. Nerve conduction studies and EMG were compatible with axonal neuropathy.

Conduction studies in peripheral nerve.

Conventional nerve conduction studies assess only a small proportion of the fiber population in peripheral nerve. Nerve conduction velocity is a measure of the very fast conducting fibers and varies with temperature and age. The amplitude of the compound nerve action potential is determined by fibers 9-14 microns in diameter and is dependent on the number of active fibers.

The diagnostic yield of quantified electromyography and quantified muscle biopsy in neuromuscular disorders.

Electromyography (EMG), histology, and histochemistry were related in 264 patients with neuromuscular disorders classified according to history and clinical and other laboratory findings. Electromyography and histological and histochemical abnormalities were divided in specific and nonspecific criteria. Specific histochemical criteria alone identified 28% of neurogenic lesions.

Human nerve potentials evoked by tactile stimuli. 1. Maximum conduction and properties of compound potentials.

Sensory potentials were evoked by tactile stimuli to the dorso-lateral aspect of the foot and recorded via a near nerve electrode from the sural nerve. The averaged potential contained a burst of 6-8 components each 0.3-1.

Human nerve potentials evoked by tactile stimuli. II. Stimulus parameters and recruitment of components.

The effect of different parameters of the tactile stimulus on the compound potential of the human sural nerve was investigated. The time-integral of the maximal response evoked by a ramp indentation (120 micrometers/ms) was 30-50% greater than that evoked by the reversal of the indentation. The time-integrals and the shortest latencies of responses recorded during local anesthesia, confined to the skin, did not vary significantly for contact areas of the tactile probe ranging from 0.

Spontaneous electrical activity: an overview.

Spontaneous electrical activity of muscle originates either from one, a few, or a large number of muscle fibers; the responses from the latter are similar to those of motor units. Responses from one or a few fibers are those arising in the end-plate zone of normal muscle and the electrical activity is associated with denervation and myotonia. The motor unit-like activity may either be discharged at randomly varying intervals, as in fasciculations, or at intervals similar to the discharges during voluntary effort, as in hemifacial spasm, Isaacs' syndrome, and in infantile spinal muscular atrophy.

Nerve conduction, tactile sensibility, and the electromyogram after suture or compression of peripheral nerve: a longitudinal study in man.

In three patients sequential studies were performed of sensory and motor conduction after complete section and suture of the median nerve at the wrist and in one patient after partial section of the nerve. The sensory potential evoked by stimuli to digits III and I and recorded proximal to the suture line at the wrist appeared after a delay of three to four months, corresponding to a growth rate of 1.5-2.

Electrophysiology and nerve biopsy in men exposed to lead.

ABSTRACT Twenty lead-exposed men were selected on the basis of a maximum level of lead in the blood of 70-140 μg/100 ml within the past year. There was no clinical evidence of neuropathy attributable to lead and haemoglobin levels were normal. In individuals, maximum motor and sensory conduction and the amplitude of the evoked potentials were normal or borderline in the median, peroneal and sural nerves, except in the distal portion of the deep peroneal nerve.

Digital memory recorder in electromyography and nerve conduction studies.

Specifications are given: (i) for a 3-channel digital memory that, when connected to an inkjet writer, allows action potentials from muscle and nerve to be recorded without distortion (upper limiting frequency 10,000 Hz); (ii) for a 14-channel digital memory connected to a 14-channel inkjet writer for the measurement of the territory of the motor units by recording simultaneously from 14 leads of a multi-electrode spaced over the cross-section of the muscle; (iii) for a digital circuit that rejects signals that exceed a given amplitude and duration and interfere with electronic averaging of potentials from sensory nerve less than 1 muV in amplitude.

Polyneuropathy. Facts and fancies.

Some conclusions are drawn from findings in 167 consecutive patients with the ordinary "garden variety" of polyneuropathy; the aetiology was unknown in 15%. Histological findings in sural nerves were related to clinical and electrophysiological abnormalities. In some patients with discrete clinical abnormalities, sensory and motor conduction and amplitudes of evoked sensory and muscle action potentials were normal, whereas the nerve biopsy showed slight but definite abnormalities.

Nerve biopsy and conduction studies in diabetic neuropathy.

Morphological findings in sural nerves were related to nerve conduction in 12 patients with diabetic neuropathy, five with mainly sensory involvement, four with severe, symmetrical sensory-motor polyneuropathy, and three with multiple mononeuropathy. All had loss of large and small myelinated and of unmyelinated fibres, even early in the disease; segmental remyelination was the most prominent myelin alteration in teased fibres, segmental demyelination was found in only a few fibres. Axonal degeneration and Schwann cell damage seem to proceed independently of each other.

Post-tetanic mechanical tension and evoked action potentials in McArdle's disease.

The tension produced by the cramp evoked in the adductor pollicis muscle by repetitive stimuli to the nerve (20/s for 50 s) and by full voluntary effort in the brachial biceps was measured in a patient with McArdle's disease. The contracture was 17% of the peaktetanic tension, and was not associated with action potentials. Twitches superimposed on the contracture were at most diminished to half, as were their action potentials.

Diagnostic yield of the analysis of the pattern of electrical activity of muscle and of individual motor unit potentials in neurogenic involvement.

The pattern of electrical activity and the properties of individual motor unit potentials were analysed in the flexor muscles of the forearm of 15 patients with motor neurone disease and 15 patients with a lesion of the brachial plexus. The best diagnostic yield from the pattern of electrical activity was obtained when the force was 30% of maximum: The number of spikes (turns/15 s) was diminished in 70% of the patients; none showed the increase in turns characteristic of myopathy. The decrease in the number of turns was often associated with an increased incidence of long time intervals between turns and with an increased amplitude between turns.

Peroneal muscular atrophy (PMA) and related disorders. II. Histological findings in sural nerves.

Biopsy of the sural nerves distinguished two groups of patients with peroneal muscular atrophy (Charcot-Marie-Tooth): a hypertrophic type and a neuronal type. In patients with the hypertrophic type (10 nerves), 30-100 per cent of teased fibres of the sural nerve had demyelinated segments, numerous onion-bulb formations and often an increase in endoneurial space. Large and small fibres, with a diameter of more than 7 micron and less than 5 micron were diminished in number.