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Joa, Kyung-Lim,Kim, Chang- Hwan Lippincott Williams Wilkins, Inc. 2013 AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITA Vol.92 No.2
OBJECTIVE: The aim of this study was to understand the meaning of the double-peak responses in digital nerve conduction study in normal and diabetic patients. DESIGN: This was a cross-sectional and correlative study. Sixty healthy subjects (10 people per decade from 20 to 79 yrs of age; 26 men; mean age, 48 yrs) and 60 diabetic patients (10 people per decade from 22 to 79 yrs of age; 36 men, mean age, 53 yrs) were included. The composite score of the nerve conduction study was obtained. Orthodromic sensory nerve conduction studies were performed on the median nerves using submaximal stimulation. The latencies and amplitudes of first and second peaks were measured. The Toronto clinical scoring system for diabetic neuropathy was applied to all diabetic patients. RESULTS: The first and second peak latencies of both 3- and 4-cm interpeak distance in diabetic patients were significantly increased compared with those of age-matched control subjects (P < 0.05). The correlation between the Toronto clinical scoring system and first and second peak latency and amplitude were significantly high, and the correlation between the composite score and first and second peak latency and amplitude was also related. CONCLUSIONS: The double-peak response represents the far distal nerve pathophysiology. The authors suspect that they will find an increasing role in diagnosing the peripheral neuropathy, which starts at the distal nerve in centripetal pattern.
Double-Peak Response in Orthodromic Sensory Nerve Conduction of the Median Nerve
김창환,Kyung Lim Joa 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.4
Objective To understand the neural generator of double-peak potentials and the change of latency and amplitude of double peaks with aging. Method In 50 healthy subjects made up of groups of 10 people per decade from the age of 20 to 60, orthodromic sensory nerve conduction studies were performed on the median nerves using submaximal stimulation. Various stimulus durations and interstimulation distances were used to obtain each double peak in the different age groups. The latency and amplitude of the second peak were measured. Statistical analyses included one-way ANOVA and correlation tests. p-values<0.05 were considered significant. Results When the cathode moved in a proximal direction, the interpeak intervals increased. Second peak amplitudes decreased, and second peak latencies were delayed with aging (p<0.05). In some older people, second peaks were not obtained. Conclusion Our experiments indicate that the double-peak response represented the two stimulation sites under the cathode and anode. The delayed latency and decreased amplitude of the second peak that occurs with aging represented peripheral nerve degeneration in aging, which starts at the distal nerve.