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Updated: May 21, 2026

Nerve Excitability Assessment in Chemotherapy-induced Neurotoxicity
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Improving Indirect Methods for Calculating Reference Limits for Nerve Conduction Studies From Historical Data.

Tomasz Szymon Szczepanski1,2, Kristian Bernhard Nilsen1, Øystein Dunker1,2,3

  • 1Section for Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Oslo, Norway.

Muscle & Nerve
|May 19, 2026
PubMed
Summary

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This summary is machine-generated.

Improved indirect methods for nerve conduction studies (NCS) reference limits enhance diagnostic accuracy for neuromuscular disorders. Modified S-curve algorithms offer reliable results using historical data when sufficient normal measurements are available.

Area of Science:

  • Neurology
  • Biomedical Engineering
  • Clinical Diagnostics

Background:

  • High-quality reference limits for nerve conduction studies (NCS) are crucial for diagnosing neuromuscular disorders.
  • Directly calculating reference limits from healthy controls is costly and time-intensive.
  • Indirect methods (E-norms, E-Ref, MeRef) utilize historical hospital data but have limitations.

Purpose of the Study:

  • To enhance indirect methods for calculating NCS reference limits by modifying S-curve selection algorithms.
  • To improve the efficiency and accuracy of establishing reference limits from historical patient data.

Main Methods:

  • Modified E-norms, E-Ref, and MeRef algorithms were applied to a large historical NCS database.
  • Reference limits were calculated using the modified indirect methods.
Keywords:
S‐curve cutoff selectionextrapolated normsmultivariable extrapolated reference valuesnerve conduction studiesreference limits

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  • Results were validated against limits derived from 680 healthy subjects using Youden's J statistic and z-score deviation.

    • Main Results:

    • Modified methods achieved Youden's J > 0.8 and z-score deviation < 0.9 for most NCS measurements.
    • Performance was comparable or superior to unmodified methods.
    • Optimal performance required at least 500 measurements and <20% abnormal data.

    Conclusions:

    • Modifying S-curve selection algorithms significantly improves indirect NCS reference limit calculation.
    • The enhanced methods require adequate numbers and proportions of normal measurements in historical data.
    • A combination of these improved indirect methods is viable for developing reference limits from historical patient data.