2021 Workshop Handout Bundle-NCS Pitfalls

NCS Pitfalls - Bassam
Pdf Summary
Nerve conduction studies (NCS) are commonly used to diagnose and define neuromuscular pathology. However, there are many pitfalls and artifacts that can arise during NCS that are often not addressed in textbooks. These pitfalls can lead to incorrect diagnoses if not identified and resolved.<br /><br />One of the main issues is instrumentation and technical factors. It is important to be familiar with the settings and components of the instrument, such as amplifier sweep and gain setting, filter settings, and recording and stimulating electrodes. Incorrect settings or malfunctioning equipment can result in distorted responses and hampers accurate recording.<br /><br />Another pitfall is the positioning of the active and reference electrodes. The location of these electrodes in relation to each other and the electrical activity of interest is crucial for accurate data collection. Failure to position the electrodes correctly can result in recording artifacts and inaccuracies in diagnosing neuromuscular pathology.<br /><br />Stimulating electrodes can also introduce artifacts if not properly positioned. Stimulus artifact, which is the electrical disturbance created by the cathode, can interfere with the desired nerve or muscle response if the distance between the cathode and recording electrode is too short. Adjacent nerves may also be inadvertently stimulated and recorded, leading to erroneous conclusions.<br /><br />Various factors can influence NCS measurements, including temperature, age, gender, and height. Temperature, in particular, has a significant effect on NCS parameters. Decreased temperature can alter latency, conduction velocity, amplitude, and duration of responses. It is important to ensure that the limb being tested is warm enough to avoid temperature-induced artifacts.<br /><br />Overall, awareness of these pitfalls and careful attention to instrumentation, electrode positioning, and other physiological factors can help ensure accurate and reliable NCS results. These considerations can contribute to the provision of a more accurate diagnosis and treatment plan for patients with neuromuscular disorders.
Keywords
nerve conduction studies
neuromuscular pathology
pitfalls
artifacts
instrumentation
electrodes
stimulating electrodes
recording artifacts
temperature
diagnosis
ncs