title: A reappraisal of various methods for measuring motor nerve refractory period in humans.
abstract: OBJECTIVE
  To compare various techniques of stimulation and methods of analysis to estimate absolute (ARP) and relative (RRP) refractory periods in motor nerve trunks of humans.
  
  
  METHODS
  Double collision (DC) technique and two types of paired pulse (PP) technique, with test stimulation of supramaximal (PP(supra)) or submaximal (PP(sub)) intensity, were applied to 32 healthy subjects. The ulnar nerve was stimulated either at a single site (wrist) for the PP techniques or at two sites (wrist and elbow) for the DC technique, with various distal interstimuli intervals (ISIs). The elicited compound muscle action potentials (CMAPs) were recorded from the abductor digitorum minimi muscle. The DC technique provided estimates of minimal and maximal ARPs, whereas maximal RRP values were obtained with the PP techniques. Data were analyzed using three methods: a visual reading of the raw ISI-CMAP curves and two computer-aided analyses of the regression curve fitting the ISI-CMAP plots. Pain induced by each technique was assessed on a 0-10 visual analogue scale. A test-retest study was performed with the PP techniques in 12 subjects.
  
  
  RESULTS
  RP estimates varied with both the stimulation technique and the analysis method. The DC technique was more painful than the PP techniques, but provided shorter and more accurate ARP values, whereas the PP(sub) technique provided longer, but valid RRP values. Computer-aided methods of data analysis gave the lowest coefficients of test-retest variation.
  
  
  CONCLUSIONS
  Compared to the PP techniques, the DC technique allowed the evaluation of the whole distribution of ARP estimates, not distorted by muscle fiber RPs. For RRP estimation, the PP(sub) technique can be preferred to the PP(supra) technique. Finally, computer-aided methods are preferable to analyze ISI-CMAP curves.
  
  
  CONCLUSIONS
  The distribution of RP estimates can be easily and reliably assessed in whole motor nerve trunks of humans, providing valuable information to assess peripheral nerve excitability.
authors.affiliation: Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, AP-HP, Créteil 94010, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Boërio
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Hogrel
authors.forename: Alain
authors.initials: A
authors.lastname: Créange
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology*; D012032:Refractory Period, Electrophysiological / Q000502:physiology*; D013997:Time Factors