Axonal excitability measured by tracking twitch contraction force.

The present study addressed whether the excitability of motor axons could be documented by tracking a target submaximal contraction force rather than a target submaximal compound muscle action potential (CMAP). In 10 subjects, multiple excitability measures were recorded using the Trond protocol, tracking twitch contraction force and the CMAP in response to stimulation of the median nerve at the wrist and twitch force to stimulation at the motor point. With stimulation at the wrist, the findings were virtually identical with force tracking and CMAP tracking for indices dependent on unconditioned thresholds (stimulus-response curves; strength-duration properties) and when the conditioning stimulus was subthreshold (threshold electrotonus; current-threshold relationship). However, when the conditioning stimulus was supramaximal, as in recovery cycle studies, thresholds for the target force were lower in all subjects than for the target CMAP. There was variability between different subjects in the extent of this offset. However, force tracking can still be used to follow changes in refractoriness and supernormality when membrane potential changes during an experiment. The excitability indices differed with motor point stimulation, but it is argued that this could be due to the geographic dispersion of motor axons at the motor point in addition to or instead of differences in biophysical properties of the stimulated nodes. Thus, tracking twitch contraction force is a potentially valuable alternative to tracking the CMAP, but is more complicated and the results need to be interpreted with caution.