A comparison of electric and magnetic compound action signals as quantitative assays of peripheral nerve regeneration

Magnetic measurements of peripheral nerve function using a neuromagnetic current probe

The progress made during the last three decades in mathematical modeling and technology development for the recording of magnetic fields associated with cellular current flow in biological tissues has provided a means of examining action currents more accurately than that of using traditional electrical recordings. It is well known to the biomedical research community that the room-temperature miniature toroidal pickup coil called the neuromagnetic current probe can be employed to measure biologically generated magnetic fields in nerve and muscle fibers. In contrast to the magnetic resonance imaging technique, which relies on the interaction between an externally applied magnetic field and the magnetic properties of individual atomic nuclei, this device, along with its room-temperature, low-noise amplifier, can detect currents in the nano-Ampere range. The recorded magnetic signals using neuromagnetic current probes are relatively insensitive to muscle movement since these probes are not directly connected to the tissue, and distortions of the recorded data due to changes in the electrochemical interface between the probes and the tissue are minimal. Contrary to the methods used in electric recordings, these probes can be employed to measure action currents of tissues while they are lying in their own natural settings or in saline baths, thereby reducing the risk associated with elevating and drying the tissue in the air during experiments. This review primarily describes the investigations performed on peripheral nerves using the neuromagnetic current probe. Since there are relatively few publications on these topics, a comprehensive review of the field is given. First, magnetic field measurements of isolated nerve axons and muscle fibers are described. One of the important applications of the neuromagnetic current probe to the intraoperative assessment of damaged and reconstructed nerve bundles is summarized. The magnetic signals of crushed nerve axons and the determination of the conduction velocity distribution of nerve bundles are also reviewed. Finally, the capabilities and limitations of the probe and the magnetic recordings are discussed.

Recovery of neurophysiological features with time after rat sciatic nerve repair: a magneto-neurographic study

Experimental assessment of peripheral nerve regeneration in rats by electrophysiology is controversial due to low reproducibility of electrophysiological indicators and diminished quantitative evaluation in conventional experimental set-ups. Magnetoneurography (MNG) counteracts these drawbacks by magnetically recording electrophysiological signals ex vivo, thereby providing accurate and quantitative data. In 50 rats, sciatic nerve transection was followed by direct repair. MNG outcome parameters, footprints [static toe spread factor (TSF); function] and muscle weight (MW) were studied for their recovery pattern from 2 to 24 weeks. By using MNG, we showed that the regeneration process still continues when functional recovery (static TSF) becomes stagnant. With regression analysis, MNG parameters amplitude, amplitude area and conduction velocity (CV) demonstrated moderate significant correlation with MW, whereas CV was not significantly associated with static TSF. No significant association exists between MW and static TSF. A Kaplan-Meier survival curve revealed that autotomy/contracture of rat hind paws was not related to decreased MNG outcome values. In conclusion, this study highlights and discusses the dissimilarities between direct (MNG) and indirect (static TSF and MW) assessment techniques of the regeneration process. We emphasise the significance of MNG as a direct derivative of axon regeneration in experimental rat studies. Additionally, we stress the must for right-left ratios, as neurophysiological indicators vary with age, and we confute possible bias in footprint analysis caused by exclusion of autotomy/contracture animals.

Nerve compound action current (NCAC) measurements and morphometric analysis in the proximal segment after nerve transection and repair in a rabbit model

In the evaluation of nerve regeneration using magneto-neurography (MNG), the proximal segment showed a reproducible decrease in peak-peak amplitude of the nerve compound action current's (NCAC) of 60%. To explain these changes, morphometry of myelinated axons in the proximal segment is compared to the MNG signals. A standardised nerve transection and reconstruction was performed in rabbits. NCACs were measured approximately 5 cm proximal to the lesion from operated and control nerves after 12 weeks. Histological samples were taken from the same area of the nerve where the NCACs were obtained. Results showed a decrease of the peak-peak amplitude of the NCAC of 57% compared to the control. Conduction velocity decreased 15% (not significant). Morphometry elicited a decrease in larger (10-15 microm) axons (284 +/- 134 vs 82 +/- 55) and an increase in smaller (2-5 microm) axons (1445 +/- 360 vs 1921 +/- 393). A strong correlation existed between the decrease in amplitude and the decrease in larger axons (0.85). Peak-peak amplitude varies approximately with the square of the diameter axon. Therefore, because peak-peak amplitude is mainly dependent on the larger-diameter axons, the decrease in peak-peak amplitude of the NCACs may be explained by a decrease in numbers of 10-15-microm axons.

Conduction velocity of the rabbit facial nerve: a noninvasive functional evaluation

The aim of this study was to evaluate standardized conduction velocity data for uninjured facial nerve and facial nerve repaired with autologous graft nerves and synthetic materials. An evaluation was made measuring the preoperative differences in the facial nerve conduction velocities on either side, and ascertaining the existence of a positive correlation between facial nerve conduction velocity and the number of axons regenerated postoperatively. In 17 rabbits, bilateral facial nerve motor action potentials were recorded pre- and postoperatively. The stimulation surface electrodes were placed on the auricular pavilion (facial nerve trunk) and the recording surface electrodes were placed on the quadratus labii inferior muscle. The facial nerves were isolated, transected and separated 10 mm apart. The gap between the two nerve ends was repaired with autologous nerve grafts and PTFE-e (polytetrafluoroethylene) or collagen tubes. The mean of maximal conduction velocity of the facial nerve was 41.10 m/s. After 15 days no nerve conduction was evoked in the evaluated group. For the period of 2 and 4 months the mean conduction velocity was approximately 50% of the normal value in the subgroups assessed. A significant correlation was observed between the conduction velocity and the number of regenerated axons. Noninvasive functional evaluation with surface electrodes can be useful for stimulating and recording muscle action potentials and for assessing the functional state of the facial nerve.

Magnetoneurography: recording biomagnetic fields for quantitative evaluation of isolated rat sciatic nerves

Magnetoneurography (MNG) is a technique to record the biomagnetic action fields of peripheral nerves. The benefits of MNG in contrast to electroneurography include the decreased signal disturbance caused by surrounding biological tissues and the use of a calibration pulse, both of which contribute to high reproducibility. MNG has proven to be a valuable tool to quantitate peripheral nerve regeneration in rabbits. However, the most commonly used model to study the peripheral nervous system is the rat sciatic nerve. Until now, the small size of the nerve impeded accurate MNG measurements in rat. This report describes a custom made recording chamber that allows accurate control of conduction distances and temperature and enables adequate MNG measurements of isolated sciatic nerves of Wistar rats. We applied biphasic stimulation with optimized grounding to reduce the stimulus artefact. A high reproducibility of signals was demonstrated. 'Ex vivo' nerve viability was assured for at least 2 h after dissection. In conclusion, MNG is a powerful tool to quantitatively evaluate the function of rat sciatic nerves and will be used for the early assessment of nerve regeneration.

Changes in the compound action current amplitudes in relation to the conduction velocity and functional recovery in the reconstructed peripheral nerve

The average axon diameter in the proximal segment of a transected and reconstructed peripheral nerve will decrease shortly after the transection and increase again when the regenerating axons make contact with their targets. The magnetically recorded nerve compound action current (NCAC) amplitude and the conduction velocity (CV) are directly related to the axon diameters. In this experiment, the peroneal nerve was unilaterally transected and reconstructed in 42 rabbits. After 3, 4.5, 6, 8, 12, 20, and 36 weeks of regeneration time, hind leg motor function recovery, NCAC amplitude, and CV(1st peak) were studied. Our results demonstrate a significant decrease in signal amplitude and CV in the first 8 weeks after reconstruction. These decreases are related (P < 0.05). After 8 weeks of regeneration time, motor function and the CV of the recorded signals start to recover, but the signal amplitudes do not. Based on the correlation of the CV and signal amplitude with axon diameter, they would both be expected to increase with recovering function. As an explanation for this lack of increase of signal amplitude, we suggest that, at the same time as some axons reach their target organs and start to mature, a number of the axons which have not reached a proper target organ will lose their signal-conducting capability. This will cause a decrease in compound signal amplitude, which cancels out the expected increase in NCAC amplitude, due to axonal maturation.

A magnetic evaluation of peripheral nerve regeneration: I. The discrepancy between magnetic and histologic data from the proximal segment

Histologic techniques can quantify the number of axons in a nerve, but give no information about electrical conductibility. The number of functional myelinated neuronal units in a nerve can be quantified based on a magnetic recording technique. When studying reconstructed peripheral nerves a significant difference between the results found with these two techniques can be observed. A comparison was made between the long-term changes in the number of histologically and magnetoneurophysiologically measured neuronal units proximal to a nerve reconstruction. This study was performed on 6 New Zealand White rabbits, 20 weeks after the peroneal nerve had been reconstructed. The contralateral nerves were used as a control. Histologic examination demonstrates a statistically significant decrease of approximately 5% in the number of myelinated fibers. The magnetoneurophysiological results demonstrate a decrease which is estimated to be caused by the loss of approximately 50% of the functional myelinated neuronal units in the nerve. Therefore we conclude that of the initially available myelinated neuronal units, 5% degenerate completely, 45% are vital but lose their signal conducting capability, and the remaining 50% are vital and continue to conduct signals. Apparently, only this latter group of 50% of the initially available functional neuronal units appears to remain available for functional recovery.

A magnetic evaluation of peripheral nerve regeneration: II. The signal amplitude in the distal segment in relation to functional recovery

Motor and sensory function in a healthy nerve is strongly related to the number of neuronal units connecting to the distal target organs. In the regenerating nerve the amplitudes of magnetically recorded nerve compound action currents (NCACs) seem to relate to the number of functional neuronal units with larger diameters regenerating across the lesion. The goal of this experiment was to compare the signal amplitudes recorded from the distal segment of a reconstructed nerve to functional recovery. To this end, the peroneal nerves of 30 rabbits were unilaterally transected and reconstructed. After 6, 8, 12, 20, and 36 weeks of regeneration time the functional recovery was studied based on the toe-spread test, and the nerve regeneration based on the magnetically recorded NCACs. The results demonstrate that the signal amplitudes recorded magnetically from the reconstructed nerves increase in the first 12 weeks from 0% to 21% of the amplitudes recorded from the control nerves and from 21% to 25% in the following 23 weeks. The functional recovery increases from absent to good between the 8th and the 20th week after the reconstruction. A statistically significant relation was demonstrated between the signal amplitude and the functional recovery (P < 0.001). It is concluded that the magnetic recording technique can be used to evaluate the quality of a peripheral nerve reconstruction and seems to be able to predict, shortly after the reconstruction, the eventual functional recovery.

Loss of viable neuronal units in the proximal stump as possible cause for poor function recovery following nerve reconstructions

Function recovery after nerve reconstructions is often poor. Could this be caused by a loss of viable neuronal units proximal to the nerve reconstruction? The number of neuronal units (i.e., a motor or sensory neuron, including its axon and axonal branches) in the proximal segments of reconstructed peripheral nerves were studied using a novel magnetic recording technique. In five rabbits a common personal nerve was transected and microsurgically reconstructed. After 8 weeks regeneration time the nerve compound action signals were recorded magnetically from the reconstructed as well as from the healthy contralateral peroneal nerve and from peroneal nerves of five unoperated control animals. The amplitudes of the recorded signals were compared and the diameter distribution histograms were calculated. These calculations were based on the conduction distance between the stimulator and the sensor and the conduction velocities of 30 different axon diameter classes ranging from 3 to 18 microns. Our results indicate that there is a reduction of approximately 50% in the number of viable neuronal units at 10 mm proximal to a simple nerve reconstruction after 8 weeks regeneration time. The number of neuronal units innervating a hand is strongly correlated with clinical function in a healthy hand. The reduction in viable neuronal units after a reconstruction, demonstrated in our experiments, corresponds with a frequently clinically observed decrease in function after nerve reconstructions. Therefore, we suggest that the number of viable neuronal units may be a good indicator of final functional recovery.