Long lasting excitability changes in human peripheral nerve

When pairs of equal but submaximal electrical stimuli are delivered to a peripheral nerve, the second stimulus does not always excite the same number of fibers as the first. The number of fibers responding to the second stimulus depends on the interstimulus interval; the refractory period, a well-defined period of hypoexcitability, is followed by longer lasting and less well-characterized periods of hyper- and hypoexcitability. These cycles last at least 200 ms after the initial stimulus. We have carefully studied these cycles of excitability in human peripheral nerve in 12 normal subjects. The magnitude of excitability changes were found to be much greater in motor fibers than in mixed nerve; under some conditions, the motor response was reduced by more than 80% at interstimulus intervals of 40 ms, while the mixed nerve response never varied by more than 20%. In addition, the amplitude of the excitability changes varied as a function of the stimulus strength, so that stimuli that were near threshold or evoked near maximal responses were associated with smaller excitability changes than stimuli evoking midrange responses. Given that the excitability fluctuations are of large magnitude and occur at interresponse intervals easily achieved during physiological firing, it is suggested that they may be important modifiers of firing rate under experimental or physiological conditions.