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Walter Eichler (1904-1942) performed the first in situ nerve conduction studies in humans. Eichler's work has been largely overlooked and there have been no biographical accounts written of him. His 1937 paper, Über die Ableitung der Aktionspotentiale vom menschlichen Nerven in situ (On the recording of the action potentials from human nerves in situ) was translated and reviewed. Archival material was obtained on his career that was housed predominantly at the University of Freiburg im Breisgau. He had memberships in Nazi organizations but did not appear to be politically active. During his brief career, he constructed novel equipment and established seminal principles for performing nerve conductions on humans. The authors repeated his experiment in the ulnar nerve, which duplicated Eichler's findings. His recordings were quite remarkable given advances in technology. In summary, the Eichler paper is the first study in the development of in situ clinical electroneurography in humans. Many of his procedural observations are still fundamental in the current practice of electroneurography. As best can be determined, his study in humans did not appear ethically compromised. Although Eichler's personal background remains open to question, his paper is a seminal study in the history and development of clinical electroneurography. Abbreviations: AP: Action potential; C: Capacitor; CNP: Compound nerve potential; DC: Direct current; E1: Preferred term for active electrode; E2: Preferred term for reference electrode; NSDÄB: Nationalsozialistische Deutsche NSD-Ärtzebund (National Socialist German Doctors' League; NSDAP: Nationalsozialistische Deutsche Arbeiterpartei (National Socialist German Workers' Party/ Nazi Party); SS: Schutzstaffel (Protective Echelon or Squad of the Nazi party).

Introduction/aims: Switching between different types of electrodes during motor and sensory nerve conduction studies adds time to a study. We investigated the use of disposable disc electrodes (DDE) used for motor nerve conduction studies to record the antidromic sensory nerve action potential (SNAP) in median, ulnar and radial sensory nerve conduction studies., Methods: The SNAP was recorded using four different electrode types: reusable ring, reusable bar, disposable ring, and DDE in a random rotating order. Studies were performed in healthy subjects. Other than being an adult with no history of neuromuscular disease, there were no exclusion criteria., Results: We studied 20 subjects (11 females, 9 males; age 41.1 ± 15.7 y). The SNAP waveforms recorded by all four electrode types were similar. There was no statistically significant difference in the onset latency, peak latency (PL), negative peak amplitude (NPA), peak to peak amplitude, or conduction velocity. In individual nerve recordings, the absolute PL difference between reusable ring electrodes (our current standard) and DDE was less than 0.2 ms in 58 of 60 (97%) nerves. The mean absolute NPA difference was 3.1 μV (standard deviation = 2.85 μV). Recordings with NPA difference >5 μV also had high NPA and/or had large artifacts., Discussion: DDE may be used for performing motor and sensory nerve conduction studies. This can reduce the time required for electrodiagnostic testing., (© 2023 Wiley Periodicals LLC.)

Introduction/aims: Low-amplitude compound muscle action potential (CMAP) suggests a neuromuscular pathology. Low amplitude will also result from a defective E1 electrode or its lead, that is, a technical artifact. The aim of this study was to investigate the effect of a defective E2 electrode lead on the CMAP., Methods: The CMAP was recorded using standard nerve conduction methodology and all electrode leads connected properly. Signals were then recorded when either the E1 or the E2 electrode lead was disconnected from the amplifier. This simulated a defective electrode lead. Studies were performed in four nerves of a healthy subject., Results: CMAP amplitude was reduced as expected when E1 was disconnected. Surprisingly, the amplitude fell by more than 65% when the E2 lead was disconnected, although E1 was properly connected., Discussion: E1 and E2 electrodes contribute to the CMAP. A defective recording electrode lead to E1 or E2 results in a low-amplitude CMAP. The amplitude drop observed with a disconnected E2 lead was far greater than the signal recorded by the E2 electrode. This occurs due to the amplifier's inherent property to reduce the voltage difference between the E1 and E2 inputs. When E2 lead is defective, the CMAP will be an attenuated version of the signal recorded by the E1 electrode, and vice versa. When low-amplitude CMAP amplitude is observed in all conduction studies, technical artifact should be considered before exploring the pathological basis for the abnormal results., (© 2023 Wiley Periodicals LLC.)

Introduction/aims: The virtual cathode (VC) is a site near the anode where the nerve can be stimulated. Costimulation of neighboring nerves via the VC can affect recording and interpretation of responses. Hence, it is important to teach trainees the concept of the VC. The VC has been demonstrated previously with subtle changes in response latency, amplitude, and shape. Herein we describe an experiment that simply demonstrates a VC with its effects recognizable by gross changes in waveforms., Methods: Compound muscle action potentials of the abductor pollicis brevis were recorded using various placements of the cathode and anode at different stimulus intensity levels. Studies were performed in nine healthy subjects., Results: Three patterns were observed that demonstrated no stimulation, partial stimulation, and complete nerve stimulation by the VC. Partial stimulation yielded responses with long duration and low amplitude. Response patterns also depended on stimulus strength and proximity of the nerve from the skin surface., Discussion: This experiment demonstrates that nerve stimulation can occur near the anode when high-intensity stimulus is used. It also illustrates collision of action potentials. This exercise can help trainees understand potential pitfalls in nerve conduction studies, especially at very proximal stimulation sites or when high stimulus intensity is used., (© 2021 Wiley Periodicals LLC.)

Introduction: In this study we describe a method called "multivariable extrapolated reference values" (MeRef) that derives reference values (RVs) using patient data and includes the dependence of these variables on multiple patient demographic variables, such as age and height., Methods: Computer simulations were used to generate "normal" and "patient" nerve conduction data. Median, ulnar, and tibial motor nerve conduction data from 500 patients studied were tabulated. Data were analyzed using the MeRef method., Results: The simulations showed great similarity between RVs obtained from MeRef of "patient" data and traditional analysis of "normal" data. In the real patient data, MeRef gave RVs as regression equations based on patient age and/or height., Discussion: MeRef can provide RVs by including patient demographic data and does not require subject grouping. It provides parameters of multivariable linear regression and standard deviation, and requires a few hundred patient studies to define reference values., (© 2021 Wiley Periodicals LLC.)

Objective: When the compound muscle action potential (CMAP) is recorded in motor nerve conduction studies, the reference (E2) electrode can make a significant contribution to the CMAP. This study investigates the E2 recorded signal and its effect on CMAP measurements when E2 electrode is placed at different sites., Methods: The CMAP was recorded using the active electrode on the muscle belly and 4 different E2 electrodes placed at distal and proximal sites. The signal recorded by each electrode was also measured using a reference electrode on the contralateral limb. Signals were recorded from the abductor pollicis brevis, abductor digiti minimi, tibialis anterior and biceps muscles., Results: The E2 recorded a smaller signal when it was placed near or off the proximal tendon or muscle origin. This affected CMAP latency, duration for tibialis anterior. Contrary to expectation, initial upward deflection was noted for E2 signal., Conclusion: A proximal E2 position records a lower volume conducted signal and yields a CMAP that is more representative of the muscle over which the E1 (active) electrode is placed., Significance: The proposed 'Proximal E2' montage may be better suited to assess pathology., (Copyright © 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

The action potential is a regenerative electrical phenomenon observed on excitable cell membranes that allows the propagation of signals without attenuation. It is the cornerstone of neurophysiology. This chapter is a review of the action potential and its relationship to the signals that are studied in clinical neurophysiology. The first section traces the history of key scientific discoveries over the last 250 years that have led to our present-day understanding of the electrical properties of nerve and muscle. The second section considers the molecular and biophysical mechanisms that are responsible for the electrical potentials that can be measured across all eukaryotic cell membranes, but specifically in neurons, nerves, and muscle. Mechanisms underlying propagation action potentials within the nervous system are also examined. The concluding section is a brief overview of the normal "macroscopic" signals that are commonly recorded from the central and peripheral nervous system, and how they are derived from action potentials., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Tibial F-wave recordings are remarkable for their complexity and persistence. We postulate that the signal recorded by the E2 (reference) electrode causes this pattern., Methods: Tibial F-wave recordings were made from the abductor hallucis (AH) muscle using the standard montage in 10 subjects. Additional far-field simultaneous F-wave recordings were made from the AH, the base of the large toe, and the base of the small toe with the E2 placed on the contralateral foot., Results: F-wave recordings made in the standard manner and from the base of the large or small toes showed complex waveforms and similar latencies. Recordings made from the AH-contralateral foot had simple waveforms in most subjects; in 2 subjects the latencies were longer, and 1 showed reduced persistence., Conclusions: The tibial F-waves are composed primarily of volume conducted recordings of the tibial-innervated foot muscles from the E2 electrode., (© 2015 Wiley Periodicals, Inc.)

Introduction: The amplitude of the compound muscle action potential (CMAP) of abductor hallucis (AH) shows the largest drop with proximal stimulation of any routinely studied motor nerves. The cause has not been established., Methods: Four experiments of tibial motor nerve conduction in several healthy control subjects were performed using far-field recordings, collision, H-reflex, and intramuscular recordings of foot muscles., Results: The proximal CMAP showed a mean peak-peak amplitude of 66% (range 57-79%) compared with the distal response. Collision and H-reflex recordings in AH did not show evidence of a contribution from the tibial-innervated calf muscle. Needle electrode recordings of CMAPs showed consistently different latencies between different foot muscles., Conclusion: Our experiments indicate that temporal dispersion and phase cancellation between the distal tibial-innervated foot muscles recorded by the E2 (i.e., reference) electrode can explain the drop in amplitude between the proximal and distal tibial evoked CMAP., (Copyright © 2011 Wiley Periodicals, Inc.)

Introduction: Reference values (RVs) are required to separate normal from abnormal values obtained in electrodiagnostic (EDx) testing. However, it is frequently impractical to perform studies on control subjects to obtain RVs. The Extrapolated Reference Values (E-Ref) procedure extracts RVs from data obtained during clinically indicated EDx testing. We compared the E-Ref results with established RVs in several sets of EDx data.Methods: The mathematical basis for E-Ref was explored to develop an algorithm for the E-Ref procedure. To test the validity of this algorithm, it was applied to simulated and real jitter measurements from control subjects and patients with myasthenia gravis, and to nerve conduction studies from patients with various conditions referred for EDx studies.Results: There was good concordance between E-Ref and RVs for all evaluated data sets.Discussion: E-Ref is a promising method to develop RVs. Muscle Nerve 57: 90-95, 2018. [ABSTRACT FROM AUTHOR]