Pathophysiology inferred from electrodiagnostic nerve tests and classification of polyneuropathies. Suggested guidelines.
OBJECTIVE
To present criteria for pathophysiological interpretation of motor and sensory nerve conduction studies and for pathophysiological classification of polyneuropathies suggested by a group of European neurophysiologists.


METHODS
Since 1992 seven neurophysiologists from six European countries have collected random samples of their electrodiagnostic examinations for peer review medical audit in the ESTEEM (European Standardized Telematic tool to Evaluate Electrodiagnostic Methods) project. Based on existing criteria in the literature, the experience with a patient material of 572 peer reviewed electrodiagnostic examinations, and productive discussions between the physicians at workshops, the collaboration has produced a set of criteria now routinely used at the centres involved in the project.


RESULTS
The first part of the paper considers pathophysiology of individual nerve segments. For interpretation of motor and sensory nerve conduction studies, figures showing change in amplitude versus change in conduction velocity/distal latency and change in F-wave frequency versus change in F-wave latency are presented. The suggested boundaries delimit areas corresponding to normal, axonal, demyelinated, or neuropathic nerve segments. Criteria for motor conduction block in upper and lower extremities are schematically depicted using the parameters CMAP amplitude and CMAP duration. The second part of the paper suggests criteria for classification of polyneuropathies into axonal, demyelinating, or mixed using the above-mentioned criteria.


CONCLUSIONS
The suggested criteria are developed during many years of collaboration of different centres and may be useful for standardization in clinical neurophysiology.


CONCLUSIONS
Consistent interpretation of nerve conduction studies is an important step in optimising diagnosis and treatment of nerve disorders.
Tankisi
Hatice
H
Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
Pugdahl
Kirsten
K
Fuglsang-Frederiksen
Anders
A
Johnsen
Birger
B
de Carvalho
Mamede
M
Fawcett
Peter R W
PR
Labarre-Vila
Annick
A
Liguori
Rocco
R
Nix
Wilfred A
WA
Schofield
Ian S
IS
D001369:Axons / Q000502:physiology; D016208:Databases, Factual / Q000639:trends; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000503:physiopathology; D004493:Education; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards*; D004594:Electrophysiology / Q000379:methods / Q000592:standards*; D005060:Europe; D009477:Hereditary Sensory and Autonomic Neuropathies / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007391:International Cooperation; D009046:Motor Neurons / Q000502:physiology; D009431:Neural Conduction / Q000502:physiology*; D009460:Neurologic Examination; D009475:Neurons, Afferent / Q000502:physiology; D009482:Neurophysiology / Q000379:methods / Q000592:standards*; D010525:Peripheral Nerves / Q000503:physiopathology*; D011115:Polyneuropathies / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies; D011930:Reaction Time / Q000502:physiology; D012985:Software Design