Ann Rehabil Med.  2011 Aug;35(4):541-547. 10.5535/arm.2011.35.4.541.

Double-Peak Response in Orthodromic Sensory Nerve Conduction of the Median Nerve

• Joa KL
• Kim CH

• KMID: 1971721
• DOI: http://doi.org/10.5535/arm.2011.35.4.541

Abstract

OBJECTIVE
To understand the neural generator of double-peak potentials and the change of latency and amplitude of double peaks with aging. METHOD: In 50 healthy subjects made up of groups of 10 people per decade from the age of 20 to 60, orthodromic sensory nerve conduction studies were performed on the median nerves using submaximal stimulation. Various stimulus durations and interstimulation distances were used to obtain each double peak in the different age groups. The latency and amplitude of the second peak were measured. Statistical analyses included one-way ANOVA and correlation tests. p-values<0.05 were considered significant.
RESULTS
When the cathode moved in a proximal direction, the interpeak intervals increased. Second peak amplitudes decreased, and second peak latencies were delayed with aging (p<0.05). In some older people, second peaks were not obtained.
CONCLUSION
Our experiments indicate that the double-peak response represented the two stimulation sites under the cathode and anode. The delayed latency and decreased amplitude of the second peak that occurs with aging represented peripheral nerve degeneration in aging, which starts at the distal nerve.

Keyword

Nerve conduction study; Double peak response; Aging; Nerve degeneration

MeSH Terms

Aging
Electrodes
Humans
Median Nerve
Nerve Degeneration
Neural Conduction
Peripheral Nerves

Figure

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  Fig. 1 Orthodromic stimulation of median sensory nerve on third finger tip.

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  Fig. 2 Double-peak sensory nerve action potential at slightly increasing stimulation intensity at interstimuli interval of 4 cm and stimulation duration of 0.1 ms. We measured the amplitude as the maximum peak-to-peak amplitude. For example, we detected the second peak amplitude of trace 2 (from 4 to 5). When supramaximal stimulation intensity reached the compound sensory action potential (CSAP) we obtained, we measured the amplitude of CSAP as maximum peak to-peak amplitude (from 2 to 3).

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  Fig. 3 There was a significant positive relationship between age (year) and stimulation intensity (mA) (r=0.547, p<0.01) by Pearson's correlation test.

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