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Utility of the distal compound muscle action potential duration for diagnosis of demyelinating neuropathies
Author(s) -
Isose Sagiri,
Kuwabara Satoshi,
Kokubun Norito,
Sato Yasunori,
Mori Masahiro,
Shibuya Kazumoto,
Sekiguchi Yukari,
Nasu Saiko,
Fujimaki Yumi,
Noto Yuichi,
Sawai Setsu,
Kanai Kazuaki,
Hirata Koichi,
Misawa Sonoko
Publication year - 2009
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/j.1529-8027.2009.00226.x
Subject(s) - chronic inflammatory demyelinating polyneuropathy , medicine , compound muscle action potential , receiver operating characteristic , amyotrophic lateral sclerosis , polyradiculoneuropathy , tibial nerve , ulnar nerve , polyneuropathy , cardiology , surgery , guillain barre syndrome , electrophysiology , elbow , stimulation , pediatrics , antibody , disease , immunology
To assess the significance of distal compound muscle action potential (CMAP) duration for diagnosis of demyelinating neuropathies, electrophysiologic data were reviewed from 471 subjects, including 145 normal controls, 60 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), 205 with other neuropathy, and 61 with amyotrophic lateral sclerosis (ALS). The duration of distally evoked CMAP was measured in the median, ulnar, tibial, and peroneal nerves. Optimal cut‐off values were calculated with receiver‐operating characteristic (ROC) curves. In comparison of normal controls and CIDP patients, ROC analyses showed the sufficient area under the curves (82‐93%). When the cut‐off values in the detection of demyelination were determined as the point with 98% specificity vs. normal on the ROC curves (median, 6.6 ms; ulnar, 6.7 ms; peroneal, 7.6 ms; tibial, 8.8 ms), the sensitivity was 77% for CIDP, with a specificity of 90% vs. ALS and 95% vs. diabetic neuropathy. The distal CMAP duration is a useful index for the detection of distal demyelination. We suggest the above cut‐off values for each nerve as one of the electrodiagnostic criteria for demyelinating neuropathies, preferentially affecting the distal nerve terminals, such as CIDP.