Pedro Pereira1, João Leote2, Christopher Cabib3, Jordi Casanova-Molla3, Josep Valls-Sole3. 1. Neurology Department, Hospital Garcia de Orta, Almada, Portugal; EMG Unit, Neurology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain. Electronic address: pedro.mdap@gmail.com. 2. Neurosurgery Department, Hospital Garcia de Orta, Almada, Portugal; EMG Unit, Neurology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain. 3. EMG Unit, Neurology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Abstract
OBJECTIVE: In routine nerve conduction studies supramaximal electrical stimuli generate sensory nerve action potentials by depolarization of nerve fibers under the cathode. However, stimuli of submaximal intensity may give rise to action potentials generated under the anode. We tested if this phenomenon depends on the characteristics of stimulus ending. METHODS: We added a circuit to our stimulation device that allowed us to modify the end of the stimulus by increasing the time constant of the decay phase. RESULTS: Increasing the fall time caused a reduction of anode action potential (anAP) amplitude, and eventually abolished it, in all tested subjects. We subsequently examined the stimulus waveform in a series of available electromyographs stimulators and found that the anAP could only be obtained with stimulators that issued stimuli ending sharply. CONCLUSION: Our results prove that the anAP is generated at stimulus end, and depends on the sharpness of current shut down. Electromyographs produce stimuli of varying characteristics, which limits the reproducibility of anAP results by interested researchers. SIGNIFICANCE: The study of anodal action potentials might be a useful tool to have a quick appraisal of distal human sensory nerve excitability.
OBJECTIVE: In routine nerve conduction studies supramaximal electrical stimuli generate sensory nerve action potentials by depolarization of nerve fibers under the cathode. However, stimuli of submaximal intensity may give rise to action potentials generated under the anode. We tested if this phenomenon depends on the characteristics of stimulus ending. METHODS: We added a circuit to our stimulation device that allowed us to modify the end of the stimulus by increasing the time constant of the decay phase. RESULTS: Increasing the fall time caused a reduction of anode action potential (anAP) amplitude, and eventually abolished it, in all tested subjects. We subsequently examined the stimulus waveform in a series of available electromyographs stimulators and found that the anAP could only be obtained with stimulators that issued stimuli ending sharply. CONCLUSION: Our results prove that the anAP is generated at stimulus end, and depends on the sharpness of current shut down. Electromyographs produce stimuli of varying characteristics, which limits the reproducibility of anAP results by interested researchers. SIGNIFICANCE: The study of anodal action potentials might be a useful tool to have a quick appraisal of distal human sensory nerve excitability.