User:Alec DeFilippo/NCV SB

Nerve conduction velocity is an important aspect of nerve conduction studies. It is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, including age, sex, and various medical conditions. Studies allow for better diagnoses of various neuropathies, especially demyelinating conditions as these conditions result in reduced or non-existent conduction velocities.

Normal Conduction Velocities
Ultimately, conduction velocities are specific to each individual and largely depend on an axon's diameter and the degree to which that axon is myelinated, but the majority of 'normal' individuals fall within defined ranges.

Nerve impulses are extremely fast, with some myelinated neurons conducting at speeds up to 120 m/s (432 km/h)

Different sensory receptors are innervated by different types of nerve fibers. Proprioceptors are innervated by type Ia, Ib and II sensory fibers, mechanoreceptors by type II and III sensory fibers and nociceptors and thermoreceptors by type III and IV sensory fibers.

Normal impulses in peripheral nerves of the legs travel at 40-45 m/s, and 50-65 m/s in peripheral nerves of the arms. Largely generalized, normal conduction velocities for any given nerve will be in the range of 50-60 m/s.

Nerve Conduction Studies
Nerve Conduction Velocity is just one of many measurements commonly made during a nerve conduction study (NCS). The purpose of these studies is to determine whether nerve damage is present and how severe that damage may be.

Nerve conduction studies are performed as follows: Calculating nerve conduction velocities from these recordings is trivial. The distance between the electrodes is simply divided by the time difference between stimulation from the first electrode and pickup by the second electrode.
 * Two electrodes are attached to the subject's skin over the nerve being tested.
 * Electrical impulses are sent through one electrode to stimulate the nerve.
 * The second electrode records the impulse sent through the nerve as a result of stimulation.

Many times, Needle EMG is also performed on subjects at the same time as other NCS procedures because they aid in detecting whether muscles are functioning properly in response to stimuli sent via their connecting nerves. EMG is the most important component of electrodiagnosis of motor neuron diseases as it often leads to the identification of motor neuron involvement before clinical evidence can be seen.

Micromachined 3D Electrode Arrays
Typically, the electrodes used in an EMG are stuck to the skin over a thin layer of gel/paste. This allows for better conduction between electrode and skin. However, as these electrodes do not pierce the skin, there are impedances which result in erroneous readings, high noise levels, and low spatial resolution in readings.

To address these problems, new devices are being developed, such as 3-dimensional electrode arrays. These are MEMS devices that consist of arrays of metal micro-towers capable of penetrating the outer layers of skin, thus reducing impedance.

Benefits of microelectrode arrays include:
 * Electrodes are about 1/10 the size of standard wet surface electrodes
 * Arrays of electrodes can be created and scaled to cover areas of almost any size
 * Reduced impedance
 * Improved signal power
 * Higher amplitude signals
 * Allow better real-time nerve impulse tracking

Anthropometric and Other Individualized Factors
Baseline nerve conduction measurements are different for everyone as they are dependent upon the individual's age, sex, local temperatures, and other anthropometric factors such as hand size or height. It is important to understand the effect of these various factors on the normal values for nerve conduction measurements to aid in identifying abnormal nerve conduction study results. The ability to predict normal values in the context of an individual's anthropometric characteristics increases the sensitivities and specificities of electrodiagnostic procedures.

Age
Normal 'adult' values for conduction velocities are typically reached by age 4. Conduction velocities in newborns and toddlers tend to be about half the adult values.

Nerve conduction studies performed on healthy adults revealed that age was negatively associated with the sensory amplitude measures of the Median, Ulnar, and Sural nerves. Negative associations were also found between age and the conduction velocities and latencies in the Median sensory, Median Motor, and Ulnar sensory nerves. However, conduction velocity of the Sural nerve is not associated with age. In general, conduction velocities in the upper extremities decreases about 1 m/s for every 10 years of age.

Sex
Sural nerve conduction amplitude is significantly smaller in females than males, and the latency of the impulses is longer in females. Other nerves don't seem to be gender biased.

Temperature
In general, the conduction velocities of most motor and sensory nerves are positively and linearly associated with body temperature (low temperatures slow nerve conduction velocity and higher temperatures increase conduction velocity).

Conduction velocities in the Sural nerve seem to exhibit an especially strong correlation with the local temperature of the nerve.

Height
Conduction velocities in both the Median sensory and Ulnar sensory nerves are negatively related to an individual's height, which likely accounts for the fact that among most of the adult population, conduction velocities between the wrist and digits of an individual's hand decrease by 0.5 m/s for each inch increase in height.

Related to this, conduction latency within the Median, Ulnar, and Sural nerves increases with height.

The correlation between height and the amplitude of impulses in the sensory nerves is negative.

Hand Factors
Circumference of the index finger appears to be negatively associated with conduction amplitudes in the Median and Ulnar nerves. Additionally, people with larger wrist ratios (the ratio of the anterior-posterior diameter to the medial-lateral diameter of a wrist) have lower Median nerve latencies.

Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis (ALS) aka 'Lou Gehrig's disease' is a progressive and inevitably fatal neurodegenerative disease affecting the motor neurons. Because ALS shares many symptoms with other neurodegenerative diseases, it can be difficult to diagnose properly. The best method to establish a diagnosis is via electrodiagnostic evaluation. Specifically, motor nerve conduction studies of the median, ulnar, and peroneal muscles should be performed, as well as sensory nerve conduction studies of the ulnar and sural nerves.

In patients with ALS, it's been shown that distal motor latencies and slowing of conduction velocity worsened as the severity of muscle weakness increased in these patients, which is consistent with the axonal degeneration occurring in ALS patients.

Carpal Tunnel syndrome

 * Description of Carpal tunnel syndrome.
 * Locations (physiological) for electrodiagnostic testing
 * Normal NCV measures (digit-wrist, other nerves)
 * Degrees of Carpal Tunnel based on NCVs
 * Tables of data
 * Other

Guillain-Barre syndrome
Guillain–Barré syndrome (GBS) is a peripheral neuropathy involving the degeneration of myelin sheathing and/or nerves that innervate the head, body, and limbs. This degeneration is due to an autoimmune response typically initiated by various infections.

Two primary classifications exist: demyelinating (Schwann cell damage) and axonal (direct nerve fiber damage). Each of these then branches into additional sub-classifications depending on the exact manifestation. In all cases though, the condition results in weakness or paralysis of limbs, or the potentially fatal paralysis of respiratory muscles.

The disease can progress very rapidly once symptoms present (severe damage can occur within as little as a day). Nerve conduction studies are critical for this reason, as electrodiagnosis is one of the fastest and most direct methods of determining the presence of the illness and its classification. Without proper electrodiagnostic assessment, GBS is commonly misdiagnosed as Polio, West Nile virus, Tick paralysis, various Toxic neuropathies, CIDP, Transverse myelitis, or Hysterical paralysis. Two sets of nerve conduction studies should allow for proper diagnosis of Guillain–Barré syndrome. It is recommended these be performed within the first 2 weeks of symptom presentation and again sometime between 3 and 8 weeks.

Electrodiagnostic findings that may implicate GBS include:.
 * Complete conduction blocks
 * Abnormal or absent F waves
 * Attenuated compound muscle action potential amplitudes
 * Prolonged motor neuron latencies
 * Severely slowed conduction velocities (sometimes below 20 m/s)

Lambert-Eaton Myasthenic Syndrome
Lambert–Eaton myasthenic syndrome (LEMS) is an autoimmune disease in which auto-antibodies are directed against voltage-gated calcium channels at presynaptic nerve terminals. Here, the antibodies inhibit the release of neurotransmitters, resulting in muscle weakness and autonomic dysfunctions.

Nerve conduction studies performed on the Ulnar motor and sensory, Median motor and sensory, Tibial motor, and Peroneal motor nerves in patients with LEMS have shown that the conduction velocity across these nerves is actually normal. However, the amplitudes of the compound motor action potentials may be reduced by up to 55%, and the duration of these action potentials decreased by up to 47%.

Peripheral Diabetic Neuropathy
At least half the population with Diabetes mellitus is also affected with Diabetic neuropathy, causing numbness and weakness in the peripheral limbs. Studies have shown that the Rho/Rho-kinase signaling pathway is more active in individuals with diabetes and that this signaling activity mainly occurs in the Nodes of Ranvier and Schmidt-Lanterman incisures. Therefore, over-activity of the Rho/Rho-kinase signaling pathway may inhibit nerve conduction.

Motor Nerve Conduction Velocity studies revealed that conductance in diabetic rats was about 30% lower than that of the non-diabetic control group. Additionally, activity along the Schmidt-Lanterman incisures was non-continuous and non-linear in the diabetic group, but linear and continuous in the control. These deficiencies were eliminated after the administration of Fasudil to the diabetic group, implying that it may be a potential treatment.