MOTOR NERVE

CONDUCTION STUDY
PRESENTED BY MOHANIESHWARI.M
Contents
Introduction
Apparatus
Procedure
Interpretation
Definition
Itis an electrodiagnostic examination
Identifies features
◦ Demyelination
◦ Axon loss
◦ Defects of NMJ transmission
◦ Reflects severe muscle fiber loss
Apparatus
Electrodes:
◦ Active electrode
◦ Reference electrode
◦ Ground electrode
Electrodes are made up of variety of
metals such as stainless steel, platinum,
silver chloride, silver, gold
Filter
◦ It is a device which selectively restricts the
frequency of the signal.
Amplifier
◦ To measure the action potential, the AP
generated in the nerve must flow through the
electrode into the amplifier & return into the
patient through ground electrode
Display
In analogue display the
neurophysiological signals are displayed
following amplification and filtering.
In digital display, an analogue to digital
converter and digital techniques are
required.
Procedure
Recording
Display
Measurement
Interpretationof action potential arising
from the peripheral nerves
Electrical stimulation of the nerve
Surface electrode= 0.5-1.0 cm in diameter
Stimulating electrode consists:
o Cathode (negative pole) – negative charges
depolarizes nerve
o Anode (positive pole)- positive charges
hyperpolarize the nerve
Stimulus intensity & duration:
o Duration-output impulse of 0.1ms
o Intensity-10-30mA
Motor nerve conduction study consists of
stimulating the nerve at two or more points
along its course & recording the muscle action
potential.
MEASUREMENTS
ONSET LATENCY
DURATION
AMPLITUDE
NERVE CONDUCTION VELOCITY
PARAMETERS

 A healthy nerve requires a square wave

pulse of 0.1ms duration & intensity of 5-
40mA
 Diseased nerve requires 40-50mA
 Filter setting- 5Hz-10Hz
 Sweep speed 2-5ms/division
Calculation of conduction velocity
D= is the distance between proximal and
distal stimulation in mm
Lp= is the proximal latency in ms
Ld= distal latency in ms
 Interpretation
Abnormalities :
1. Reduced amplitude
with normal or slightly
increased latency
2. Increased latency with
relatively normal
amplitude
3. Absent response
Reduced amplitude with normal or slightly increased
latency
A shock below the
lesion elicit normal
CMAP & proximal
stimulus above the
lesion shows reduced
amplitude.
This is seen in the
initial days after the
nerve injury i.e.,
neuropraxia or early
axonotmesis
Increased latency with relatively normal amplitude

Slowed conduction
with normal
amplitude in
stimulation above the
lesion.
These changes are
seen in segmental
demyelination
without conduction
block affecting
majority of nerves.
Absent response

Itindicates that most

of the nerve fibers
fail to conduct across
the site of lesion.
Reference
Misra textbook
Jun Kimura textbook of electrodiagnosis in
diseases of nerve and muscle. Edition 3
Motor nerve conduction studies, kerry
H.Levin, handbook of clinical
neurophysiology, vol 7
 THANK YOU