The threshold tracking nerve conduction study technique: Experience of clinical users unfamiliar with a research-grade neuronal excitability system

C E McIlduff; B J Wainger; R L Freeman; S Samaan; I Yator; H Gutierrez; S Verga; S B Rutkove

doi:10.1016/j.cnp.2022.08.003

The threshold tracking nerve conduction study technique: Experience of clinical users unfamiliar with a research-grade neuronal excitability system

Clin Neurophysiol Pract. 2022 Oct 13:7:319-324. doi: 10.1016/j.cnp.2022.08.003. eCollection 2022.

Authors

C E McIlduff¹, B J Wainger^{2

3}, R L Freeman⁴, S Samaan¹, I Yator¹, H Gutierrez¹, S Verga¹, S B Rutkove¹

Affiliations

¹ Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
² Department of Neurology, Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁴ Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Abstract

Objective: To 1) explore if clinical electrophysiologists with different degrees of experience performing standard nerve conduction studies could run a threshold tracking nerve conduction study (TTNCS) protocol and 2) learn how clinical users view a research-grade TTNCSs neuronal excitability system.

Methods: Five clinical electrophysiologists conducted a TTNCS session using QTracS and then completed a questionnaire describing their impressions.

Results: All of the electrophysiologists completed the QTracS protocol on an initial attempt. Perceived strengths comprised the ease of preparatory steps and quick protocol speed. Identified drawbacks included an unwieldly user-interface. The electrophysiologists indicated that knowledge of TTNCS principles and applications would be critical for incorporation of the method into clinical use.

Conclusions: This pilot study suggests that clinical electrophysiologists can carry out TTNCSs with a research-grade system. The development of a more user-friendly program, along with dedicated education and training, could lead to wider application of the TTNCS technique.

Significance: Considered together with clinical presentation and other biomarkers, increased use of TTNCSs could provide improved assessment of neuromuscular disease and treatment response.

Keywords: Axonal excitability; Biomarker; Clinical electrophysiology; Nerve conduction studies; Neuromuscular disorders; Threshold tracking.