Various parameters of the repetitive nerve stimulation (RNS) test of the abductor digiti quinti muscle were analyzed statistically in 34 patients with Lambert-Eaton myasthenic syndrome (LEMS). The sensitivity and specificity of the increments after exercise and after 50-HZ stimulation for the diagnosis of LEMS were compared with reference values in 40 normal subjects and data from 538 tests in patients with myasthenia gravis (MG). When we used a 100% increment (the "gold standard") as the normal limit for the postexercise facilitation (PEF) or the high-rate stimulation (HRS) test, the diagnosis of LEMS was confirmed in 29 (85%) cases. When a 60% increment was used as the normal limit, the diagnosis of LEMS was made in 97% of cases. In MG, a 60% increment was observed in only 4 of 538 cases by HRS and in none by the exercise test. Thus, the use of a 60% increment showed a sensitivity of 97% for the diagnosis of LEMS and a specificity of 99% in excluding MG. A 60% increment in either the PEF or HRS test for the diagnosis of LEMS is a desirable alternative to the 100% increment previously considered to be the gold standard for this diagnosis.

Subacute inflammatory demyelinating polyneuropathy is a definite entity bridging the gap between Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy.

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Background: We investigated the effect of age on nerve conduction parameters with special reference to the compound muscle action potential (CMAP) duration and duration ratio. Method: We examined 295 subjects (aged 15–85 years old) with no previous history or present signs of peripheral neuropathy. The subjects were divided into 3 groups: young (15–34 years old); intermediate (35–64 years old), and old (65–85 years old). Results: CMAP amplitude was lower in the old group than in the young group; however, the CMAP ratio (proximal CMAP/distal CMAP) did not change with age. The CMAP duration and duration ratio did not differ among the 3 groups. The CMAP area was smaller in the old group, but the area ratio was almost constant among the 3 groups. Conclusion: We suggest that age-related changes in CMAP amplitude, duration or area may occur uniformly, at least in the forearm and the calf segment, in routine nerve conduction studies. The present findings also provide useful and reliable information, regardless of age, in diagnosing peripheral neuropathy.

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