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Correlation of EMG, CMAP and SNAP amplitude decrease in mononeuropathies with axonal loss

P B Wu1, C G Gussner, E S Date

  • 1Department of Functional Restoration, Stanford University Medical Center, USA.

Electromyography and Clinical Neurophysiology
|October 1, 1996
PubMed
Summary
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In diagnosing mononeuropathy with axonal loss, sensory nerve action potential (SNAP) amplitude decrease is more pronounced than compound muscle action potential (CMAP) decrease. CMAP decrease correlates with denervation potentials, but no significant correlation exists between CMAP and SNAP amplitude decreases.

Area of Science:

  • Neurology
  • Clinical Electrophysiology

Background:

  • Mononeuropathy with axonal loss requires precise electrodiagnostic criteria.
  • Distinguishing between nerve damage types is crucial for accurate diagnosis and treatment.

Purpose of the Study:

  • To analyze electrodiagnostic findings in patients with mononeuropathy with axonal loss.
  • To evaluate the relationship between sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) amplitude decreases.
  • To determine the correlation between CMAP amplitude decrease and denervation potentials.

Main Methods:

  • Retrospective review of electrodiagnostic studies from 1983-1994.
  • Inclusion criteria: 48 patients with mononeuropathy with axonal loss (ulnar, peroneal, radial nerves).
  • Diagnostic criteria included bilateral studies, specific amplitude decrease thresholds for SNAP and CMAP, and presence of denervation potentials, ruling out polyneuropathy.

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Main Results:

  • No significant quantitative correlation (r=0.274, p=0.06) between CMAP and SNAP amplitude percentage decrease.
  • SNAP amplitude percentage decrease (75.3% ± 31.8%) was significantly greater than CMAP amplitude percentage decrease (43.9% ± 31.3%) (p=0.0001).
  • CMAP amplitude decrease positively correlated with the presence of denervation potentials (p=0.013).

Conclusions:

  • In electrodiagnosis of mononeuropathy with axonal loss, SNAP amplitude reduction is more significant than CMAP reduction.
  • CMAP amplitude decrease is associated with denervation potentials, aiding in diagnosis.
  • The lack of strong correlation between CMAP and SNAP suggests distinct pathophysiological processes or differential susceptibility in mononeuropathy.