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DEMYELINATION AND AXONAL DEGENERATION

Sensory action potentials from the median nerve were studied in 84 patients with polyneuropathy. The recordings rendered it possible to detect responses even of 6-12 fibres of 12-6 p diameter (Buchthal and Rosenfalck 1966, Rosenfalck 1970). When velocities and amplitudes were slightly diminished and the triphasic potential was prolonged, reconstructions verified that all fibres were slowed (Buchthal and Rosenfalck 1966, 1970). The histological counterpart is then either demyelination (without block) or remyelination, or both. When involvement was severe, many fibres had ceased to conduct in addition to marked slowing and an increase in temporal dispersion from the normal 56-20 m/sec to 17-9 m/sec; the amplitudes could be reduced from normal 40 pV to 0.2 pV. In 20 patients, the abnormality was a severe reduction in amplitude of the sensory of motor responses or both, concomitant with normal conduction velocities. The changes are compatible with axonal degeneration of fibres 6-12 p in diameter. Most patients (34 of 36) with diabetic, uraemic and alcoholic polyneuropathy had electrophysiological changes compatible with demyelination without block when involvement was mild, and with block when involvement was advanced. The same applied to 18 of 24 patients with familial polyneuropathy (Charcot-Marie-Tooth and others) and of Guillain-Bark type. In 12 of 20 patients with electrophysiological signs of axonal degeneration the aetiology was unknown.