Reproduzierbarkeit der Neurografie – explorative Untersuchung

Zusammenfassung

Für klinische Entscheidungen ist die Sicherheit eines Messergebnisses und seine Variabilität ist sehr bedeutsam. Für die Neurografie liegen nur wenige Untersuchen zur Reproduzierbarkeit – Reliabilität – vor. Die vorliegende exporative Studie hatte die Ziele Schätzwerte für die beste mögliche Re-Test-Reliabilität und Hypothesen für weitere Untersuchungen mit mehr Variablen zu erstellen. Dazu wurden Nerven von 10 Gesunden von einem Untersucher an einem Typ des Neurografiegeräts gemessen.

Die F-Wellen und die motorische Leitgeschwindigkeiten in den Segmenten von Unterschenkel und Unterarm waren mit ca. 5% Abweichungen reproduzierbar. Die sensiblen Leitgeschwindigkeiten waren mit unter 10% Abweichung reproduzierbar.

Die Amplituden der motorischen Aktionspotenziale und der sensiblen Nervenantwortpotenziale haben eine begrenzte Reproduzierbarkeit.

Die Bewertung der Messwerte muss mit deutlicher Zurückhaltung erfolgen. Es ist zu erwarten, dass die Reliabilität bei Vergleichen zwischen Untersuchern deutlich geringer ist.

Abstract

For clinical decisions, the safety of a measurement result and its variability is very significant. For neurography, only a few studies on reproducibility – reliability – are available. The present explorative study aimed to provide estimates for the best possible re-test reliability and hypotheses for further studies with more variables. Nerves of 10 healthy persons were measured by an examiner on one type of neurography device. The F-waves and motor conduction velocities in the segments of the lower leg and forearm were reproducible with approximately 5% deviation. The sensitive conduction velocities were reproducible with less than 10% deviation. The amplitudes of the motor action potentials and the sensitive nerve response potentials had limited reproducibility. The evaluation of the measured values ​​must be carried out with great caution. It is to be expected that the reliability is significantly lower in comparisons between examiners.

Schlüsselworte

Neurografie - Reproduzierbarkeit - Reliabilität

Key words

Neurography - reproducibility - reliability

• Literatur

• 1 Ludin HP. Praktische Elektromyographie. 3. Aufl Stuttgart: Enke; 1988
• 2 Aminoff MJ. Aminoff´s electrodiagnosis in clinical Neurology. 6. Ed Elsevier; 2012
• 3 Kimura J. Electrodiagnosis in diseases of nerve and muscle. 4. Ed Oxford University Press; 2013
• 4 Kimura J. Facts, fallacies, and fancies of nerve conduction studies: twenty-first annual Edward H. Lambert lecture. Muscle Nerve 1997; 20: 777-787
• 5 Bleasel AF, Tuck RR. Variability of repeated nerve conduction studies. Electroenceph clin Neurophysiol 1991; 81: 417-420
• 6 Dyck PJ, Karnes JL, O´Brien PC. et al. The Rochester diabetic neuropathy study: Reassessment of test and criteria for diagnosis and stage severity. Neurology 1992; 42: 1164-1170
• 7 Claus D, Mustafa C, Vogel W. et al. Assessment of diabetic neuropathy: Definition of norm and discrimination of abnormal nerve function Muscle Nerve. 1993; 16: 757-768
• 8 Kohara N, Kimura J, Kaji R. et al. F-wave latency serves as the most reproducible measure in nerve conduction studies of diabetic polyneuropathy: multicenter analysis in healthy subjects and patients with diabetic polyneuropathy. Diabetologica 2000; 43: 915-921
• 9 Kimura J. Long and short nerve conduction measures: reproducibility for sequential assessment. J Neurol Neurosurg Psychiat 2001; 71: 427-430
• 10 Schuhfried O, Angst M, Herceg M. et al. Interexaminer repeatability of antidromic ulnar sensory nerve conduction velocity measurements. Arch Phys Med Rehabil 2005; 86: 2047-2050
• 11 Kong X, Lesser EA, Thomas J. et al. Repeatability of nerve conduction measurements using automation. J clinical Monitoring and Computing 2006; 20: 405-410
• 12 Pinheiro DS, Manzano GM, Nóbrega JA. Reproducibility in nerve conduction studies and f-wave analysis. Clin Neurophysiol 2008; 119: 2070-2073
• 13 Kong X, Lesser EA, Gozani SN. Repeatability of nerve conduction measuraments derives entirely by computer methods. BioMedical Engineering OnLine 2009; 8: 33
• 14 Ward RE, Boudreau RM, Vinik AI. et al. Reproducibility of peroneal motor nerve conduction measures in older adults. Clin Neurophysiol 2013; 124: 603-609
• 15 Van den Bergh PYK, Hadden PDM, Bouche P. et al. European Federation of neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society – First Revision European. J Neurol 2010; 17: 356-363
• 16 Bucher H, Kaminski RU. Strategien neurophysiologischer Untersuchungen. Stuttgart: Thieme; 2011
• 17 Preston DC, Shapiro BE. Elecromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations. 3. Ed. London: Elsevier; 2013
• 18 Stöhr M, Pfister R. Klinische Elektromyographie und Neurographie – Lehrbuch und Atlas. 6. Aufl. Stuttgart: Kohlhammer; 2014
• 19 Bischoff Ch, Dengler R. (Hrsg.) EMG NLG . 4. Auflag. Stuttgart Thieme; 2018
• 20 Bischoff Ch, Buchner H. (Hrsg.) SOPs Neurophysiologische Diagnostik. Stuttgart Thieme; 2018
• 21 Vogel P, Aroyo I. Kursbuch klinische Neurophysiologie. 4. Aufl. Stuttgart Thieme; 2018
• 22 Buchner H, Schönlau L, Ferbert A. Neurografie des N. Suralis. Klin Neurophysiol 2018; 49: 188-207
• 23 Lee JA, Halpern EM, Lovblom LE. et al. Reliability and validity of a point-of-care sural nerve conduction device for identification of diabetic neuropathy Plons One. 2014; 9: e86515
• 24 Dyck PJ, Litchy WJ, Daube JR. et al. Individual attributes versus composite scores of nerve conduction abnormality: sensitivity, reproducibility, and concordance with impairment Muscle Nerve. 2003; 27: 202-210
• 25 Landau ME, Diaz MI, Barner KC. et al. Changes in nerve conduction velocity across the elbow due to experimental error. Muscle Nerve 2002; 26: 838-840
• 26 Buchthal F, Rosenfalck A. Evoked action potentials and conduction velocity in human sensory nerves. Brain Res 1966; 3: 1-122
• 27 Bortz J, Doering N. Forschungsmethoden und Evaluation für Human- und Sozialwissenschaftler. 5. Aufl. Heidelberg New York: Springer; 2016
• 28 Tankisi H, Pugdahl K, Fugelsang-Frederiksen A. et al. Pathophysiology inferred from electrodiagnostic nerve tests and classification of polyneuropathies. Suggested guidelines Clin Neurophysiol. 2005; 116: 1571-1580