2023 Workshop Handout Bundle-NCS Pitfalls

NCS Pitfalls

Pdf Summary

The workshop "Nerve Conduction Study (NCS) Pitfalls" presented by Dr. Bassam Bassam and colleagues at the AANEM Annual Meeting focuses on common errors encountered during nerve conduction studies (NCS) and how to correct them to ensure accurate diagnoses. Motor and sensory NCSs are essential for diagnosing neuromuscular conditions, but they can be compromised by several artifacts and errors.<br /><br /><strong>Instrumentation and Technical Factors:</strong><br />Understanding the components and settings of recording instruments (amplifier settings, filter settings, electrode placement, and stability) is vital. Incorrect settings can lead to distorted recordings, incorrect latency measurements, and ultimately, erroneous nerve conduction velocities (NCVs). Proper calibration and duplication of instrumentation settings are necessary for valid comparisons with normative data.<br /><br /><strong>Stimulating Electrodes and Stimulus Artifact:</strong><br />Stimulating electrodes must be accurately placed to prevent artifacts and the inadvertent stimulation of adjacent nerves. Strategies to minimize stimulus artifacts include optimizing electrode placement, using appropriate stimulus intensities, and ensuring good contact with the skin using conductive paste or gel.<br /><br /><strong>Electrode Positioning:</strong><br />Correct positioning of active and reference electrodes is critical. Improper electrode separation, especially in sensory NCSs, can lead to reduced amplitudes and erroneous latency readings, giving false impressions of nerve abnormalities.<br /><br /><strong>Physiologic Factors:</strong><br />Temperature significantly affects NCS results. Lower limb or hand temperatures below recommended levels can increase latency, reduce conduction velocity, and lead to misdiagnoses of neuropathies. Age, gender, and height also influence NCS readings, with older adults showing slower velocities and reduced amplitudes.<br /><br /><strong>Technical and Interpersonal Considerations:</strong><br />Articulating findings based on inappropriate normative data or not recognizing physiological variations can lead to misinterpretations. Ensuring comparable conditions and thorough clinical correlation are paramount for accurate diagnostics.<br /><br />Conclusively, being aware of and correcting for these pitfalls leads to more reliable and accurate NCS results, aiding in the correct diagnosis and understanding of neuromuscular disorders.

Keywords

Nerve Conduction Study

ncs

ncv

NCS Pitfalls

Dr. Bassam Bassam

AANEM Annual Meeting

neuromuscular conditions

Instrument settings

Stimulating electrodes

Electrode positioning

Physiologic factors

Technical considerations

nerve conduction studies

nerve conduction study

ncs

ncv