Nerve Conduction Study Values Needed to Be Considered “Demyelinating”
NCV (m/sec)
DL (msec)
F WAVES (msec)
LLN
<80%1
<70%2
ULN
> 125%1
>150%2
ULN
>120%1
>150%2
Median
49
39.2
34.3
4.5
5.6
6.7
31.0
37.2
46.5
Ulnar
50
40.0
35.0
3.6
4.5
5.4
32.0
38.4
48.0
Peroneal
41
32.8
28.7
6.6
8.2
9.9
58.0
69.6
87.0
Tibial
41
32.8
28.7
6.0
7.5
9.0
58.0
69.6
87.0
1
2
= If Amp > 80% LLN
= If Amp < 80% LLN
If median CMAP LLN 4.5 mV; then 80% LLN = 3.6 mV
If ulnar CMAP LLN 5.0 mV; then 80% LLN = 4 mV
If peroneal CMAP LLN 2.0 mV; then 80% LLN = 1.6 mV
If tibial CMAP LLN 4.0 mV; then 80% LLN = 3.2 mV
Dimachkie MM, Barohn RJ, Katz J. Neurol Clin 2013;31:533-555
Immunosuppressive
Therapy
Route
Dose
Side Effects
Monitor
Flu-like illness, hepatoxicity, pancreatitis, leucopenia,
macrocytosis, neoplasia, infection, teratogenicity
Bone marrow suppression, hepatoxicity, neoplasia,
infertility, teratogenicity, infection
Bone marrow suppression, infertility, hemorrhagic
cystitis, alopecia, infections, neoplasia, teratogenicity
Same as p.o. (although more severe), and nausea/
vomiting, alopecia
Monthly blood count, liver
enzymes
Monthly blood count, liver
enzymes
Azathioprine
p.o.
2-3 mg/kg/day; single a.m.dose
Chlorambucil
p.o.
4-6 mg/day, single a.m. dose
p.o.
1.5-2 mg/kg/day; single a.m.
dose
i.v.
1 gm/m2
Cyclosporine
p.o.
4-6 mg/kg/day,
split into two daily doses
Nephrotoxicity, hypertension, infection, hepatoxicity,
hirsutism, tremor, gum hyperplasia, teratogenicity
Intravenous
Immunoglobulin
i.v.
2 gm/kg over 2-5 days;
then 0.4-2 gm/kg every 3-8
weeks as needed
Hypotension, arrhythmia, diaphoresis, flushing,
nephrotoxicity, headache, aseptic meningitis,
anaphylaxis, stroke
Heart rate, blood pressure,
creatinine/BUN
p.o.
7.5-20 mg weekly,
single or divided doses;
one day a week dosing
Hepatoxicity, pulmonary fibrosis, infection, neoplasia,
infertility, leucopenia, alopecia, gastric irritation,
stomatitis, teratogenicity
Monthly liver enzymes, blood
count; consider liver biopsy at
2 gm accumulative dose
Cyclophosphamide
Methotrexate
i.v./
i.m.
Methylprednisone
i.v.
Mycophenylate
Mofetil
p.o.
Prednisone
p.o.
Rituximab
i.v.
Tacrolimus
p.o.
20-50 mg weekly;
one day a week dosing
1 gm in 100 ml normal saline
over 1-2 hours, daily or every
other day for 2-6 doses
1 to 1.5 gm twice a day
100 mg/day for 2-4 weeks,
then 100 mg every other day;
taper every 2-3 months; single
a.m. dose
2 doses of 750 mg/m2
administered 2 weeks apart
0.1 to 0.2 mg/kg/day
Split into 2 daily doses
Monthly blood count, urinalysis
Daily to weekly blood count,
urinalysis
Blood pressure, monthly
cyclosporine level, creatinine/
BUN, liver enzymes
Same as p.o.
Same as p.o.
Arrhtymia, flushing, dysgeusia, anxiety, insomnia, fluid
and weight gain, hyperglycemia, hypokalemia, infection
Heart rate, blood pressure,
serum glucose/potassium
Myelosuppression, GI (diarrhea, nausea, abdominal
pain), peripheral edema, fever, infection, opportunistic
infection, malignancy, teratogenicicity
Monthly blood count
Hypertension, fluid and weight gain, hyperglycemia,
hypokalemia, cataracts, gastric irritation, osteoporosis,
infection, aseptic femoral necrosis
Weight, blood pressure, serum
glucose/potassium, cataract
formation
Mild infusion-related adverse events (headache, chills,
nausea, hypotension), anaphylaxis, infection, PML
CD 19 counts (< 5%), IgG level
(keep above 30% of the LLN)
Nephrotoxocity, GI (diarrhea, abdominal pain),
hypertension, electrolyte imbalance, tremor, infection,
hepatotoxicity, teratogenicity,
BP, Creatinine/BUN, &
electrolytes, monthly trough
level (aim 5-15 ng/ml)
Adapted and modified from Dimachkie MM, Barohn RJ. Front Neurol Neurosci 2009;26:126-46