Conduction block in compression neuropathy: recognition and quantification

Previous reports of conduction block in compression neuropathy have used the amplitude difference of the compound muscle action potential (CMAP) comparing proximal with distal stimulation. The present study was undertaken to determine if area reduction of the proximal CMAP provides diagnostic information that is not included in amplitude reduction, particularly in distinguishing conduction block from temporal dispersion. Digitized, integrated area measurements were compared with amplitude and, as a convenient estimate of area, the calculated M-index (1/2 duration X amplitude). Amplitude reduction did not reliably distinguish conduction block from temporal dispersion in compression neuropathy. Both in the investigation of conduction block and in the management of compression neuropathy, integrated area measurement allows for the more accurate identification and quantification of conduction--a usually reversible cause for weakness in compression neuropathy.