Quantitative motor unit analysis: the effect of sample size

This study of quantitative electromyography examines the influence of sample size on motor unit action potential (MUAP) tolerance limits, intertrial variability, and diagnostic sensitivity. We recorded 20 randomly selected MUAPs from the biceps muscle twice in 21 normal subjects, and once in 10 patients with myopathy. The 95% tolerance limits for mean total duration in normal subjects progressively narrowed from 6.6 to 14.2 ms for 5 MUAPs to 7.4 to 13.0 ms for 20 MUAPs. The 95% tolerance limits for intertrial variability were +/-22% for mean total duration of 20 MUAPs. Larger sample size had a greater effect on reducing intertrial variability than on narrowing 95% tolerance limits for amplitude and area. Quantitative EMG results for duration supported the presence of myopathy in 2 of 10 patients with analysis of 5 MUAPs, and 9 patients with analysis of 20 MUAPs. Although analysis of 5 potentials may be adequate for diagnosis occasionally, quantitative analysis of 20 MUAPs narrows tolerance limits, reduces intertrial variability, and improves diagnostic sensitivity.