Usefulness of an increase in size of motor unit potential sample

Objective It is known that the sensitivity of quantitative electromyographic (EMG) analysis of motor unit potentials (MUPs) improves with an increase in MUP sample size to more than 20. However, no normative data and estimate of sensitivity have been published. Methods In the present study sample sizes of 5, 10, 15, 20, 30 and 40 MUPs were obtained from the external anal sphincter (EAS) muscles of 81 controls and 70 patients with cauda equina lesions. For each sample size normative limits and sensitivities for mean values and ‘outliers’ were calculated for 8 MUP parameters. Results As the size of the MUP samples increased, normative limits narrowed and sensitivities increased for both statistics of all MUP parameters (sensitivities were 26% at 10, 44% at 20, and 67% at 40 MUPs with mean values and outliers of MUP area, duration and number of turns). Conclusions Our results confirmed a substantial increase in the sensitivity of MUP analysis by enlargement of the MUP sample size to more than 20 MUPs. The gain in sensitivity seem to be greater than the increase obtained by examination of contralateral EAS muscle. Significance Findings might be useful to clinical neurophysiologists planning strategies for electrodiagnostic evaluation of lower sacral segments.