title: Use of enhanced stimulation voltage to determine the severity of compressive peripheral nerve injury.
abstract: BACKGROUND
  The aim of this study was to investigate whether enhanced stimulation voltage could be a predictor of the extent of injury in acute compressive peripheral nerve trauma.
  
  
  METHODS
  The femoral nerves were exposed on both sides, in 11 anesthetized rabbits. Supramaximal stimulation voltage was used to produce a maximal-amplitude compound muscle action potential (CMAP) from the quadriceps femoris muscle. Afterward, the left femoral nerve was clipped for 1 minute, and the right femoral nerve for 5 minutes to produce an acute compressive injury. Immediately after removal of the clip, the proximal and distal sides of the clippage site were stimulated by gradually increased voltage until CMAPs were obtained. The same procedure was repeated at the 30th and 60th minutes. The ratio of the CMAP amplitudes obtained from proximal and distal stimulation was measured to establish a classification.
  
  
  RESULTS
  The stimulation voltages and amplitudes of the CMAPs before clippage were similar with the after-clippage values obtained from distal stimulation (p > 0.05), but the after-clippage values obtained from proximal stimulation were different in both sides (p < 0.05). Doubled stimulation voltage was enough to obtain CMAPs on the left side, but eightfold the initial level was required on the right side. The amplitude ratios recovered to preinjury levels in all of the subjects on the left side, but only two showed recovery on the right side (p < 0.001). Histopathologically, there was axonal compression without discontinuity on the left side, whereas the fibers were dispersed on the right side.
  
  
  CONCLUSIONS
  Stimulation voltage was found to discriminate the severity of the lesion in experimental peripheral nerve injury. Proximal to distal amplitude ratio seems to be a prognostic factor when the injury is less severe.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Selçuk University, Akyokuş-42080-Konya, Turkey.
authors.forename: M E
authors.initials: ME
authors.lastname: Ustün
authors.forename: T C
authors.initials: TC
authors.lastname: Oğün
authors.forename: O
authors.initials: O
authors.lastname: Eser
authors.forename: K T
authors.initials: KT
authors.lastname: Sahin
authors.forename: M C
authors.initials: MC
authors.lastname: Avunduk
mesh_terms: D000200:Action Potentials; D000818:Animals; D004558:Electric Stimulation; D005267:Femoral Nerve / Q000293:injuries* / Q000473:pathology; D018482:Muscle, Skeletal / Q000502:physiology*; D011817:Rabbits; D015599:Trauma Severity Indices