title: Repeatability of nerve conduction measurements using automation.
abstract: OBJECTIVE
  To quantify nerve conduction study (NCS) reproducibility utilizing an automated NCS system (NC-stat, NeuroMetrix, Inc.).
  
  
  METHODS
  Healthy volunteers without neuropathic symptoms participated in the study. Their median, ulnar, peroneal, and tibial nerves were tested twice (7 days apart) by the same technician with an NC-stat instrument. Pre-fabricated electrode arrays specific to each nerve were used. Both motor responses (compound motor action potential [CMAP] and F-waves - all nerves) and sensory responses (sensory nerve action potentials [SNAP] - median and ulnar nerves only) were recorded following supramaximal stimuli. Automated algorithms determined all NCS parameters: distal motor latency (DML), mean F-wave latency (FWL), distal sensory latency (DSL), CMAP amplitude, and SNAP amplitude. Latency was adjusted for skin temperature deviation from reference. Pearson correlation coefficient (CC), intraclass correlation coefficient (ICC), coefficient of variance (CoV), and relative intertrial variation (RIV) were calculated.
  
  
  RESULTS
  Fifteen subjects participated in either upper or lower extremity studies with nine participating in both. With the exception of CMAP amplitude, all parameters had CoV less than 0.06. Upper extremity amplitude parameters had CCs greater than 0.85. CCs for latencies were greater than 0.80 except for the median nerve FWL (CC = 0.69). For lower extremity nerves, ICCs were highest for mean FWL (>0.90), followed by DML (>0.82) and then CMAP (peroneal 0.33, tibial 0.73). The 10th to 90th RIV percentiles were bounded by +/-7% for F-wave latencies; +/- 9% for all DSLs; and +/- 11% for DML (except peroneal at 15%).
  
  
  CONCLUSIONS
  The reproducibility of NCS parameters obtained with an automated NCS instrument compared favorably with traditional electromyography laboratories. F-wave latencies had the highest repeatability, followed by DML, DSL, SNAP and CMAP amplitude. Given their high reproducibility, automated NCS instrument may encourage wider utilization of NCS in clinical and research applications.
authors.affiliation: NeuroMetrix, Inc, 62 Fourth Avenue, Waltham, MA 02451, USA. xuan_kong@neurometrix.com
authors.forename: Xuan
authors.initials: X
authors.lastname: Kong
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Lesser
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Megerian
authors.forename: Shai N
authors.initials: SN
authors.lastname: Gozani
mesh_terms: D000200:Action Potentials; D000328:Adult; D000465:Algorithms; D001132:Arm; D001331:Automation; D004576:Electromyography / Q000295:instrumentation / Q000706:statistics & numerical data; D004594:Electrophysiology / Q000295:instrumentation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D009431:Neural Conduction; D009475:Neurons, Afferent / Q000502:physiology; D015203:Reproducibility of Results