Neurol. praxi. 2010;11(2):81-84
Neurophysiology and electrodiagnosis of neuromuscular transmission
- Neurologická klinika LF UK a FN, Plzeň
This review summarizes the principles of normal neuromuscular transmission. Depolarization of the nerve terminal produces an influx
of calcium through voltage-gated calcium channels and acetylcholine vesicles then fuse with the presynaptic membrane. After release,
acetylcholine (ACh) interacts with the acetylcholine receptor (AChR); this opens the AChR channel, resulting in an influx of sodium. When
a sufficient quantity of ACh binds to the receptors, sodium channels in muscle membrane open, leading to depolarization of the muscle
and contraction. Electrodiagnostic studies can demonstrate a defect of neuromuscular transmission in two ways. The first is by repetitive
nerve stimulation at slow rates 2–3 Hz and detection of decrement. The second is by performing single fiber electromyography and
evaluating jitter or neuromuscular block.
Keywords: neuromuscular junction, neuromuscular transmission, repetitive nerve stimulation, single fiber electromyography
Published: April 1, 2010 Show citation
References
- Ambler Z. Neuromuskulární přenos a jeho poruchy. Přehledný referát. Ces Slov neurol N 1986; 49(82): 1-3.
- Ambler Z, St?lberg E. EMG diagnostika myasthenie gravis. Ces Slov neurol N. 1986; 49(82): 60-65.
- Ambler Z, St?lberg E. Myasthenický syndrom a jeho EMG diagnostika. Ces Slov neurol N 1986; 49(82): 66-69.
- Berman SA, Sanders DB. Assessment of neuromuscular transmission. Dostupný na http://emedicine.medscape.com/article/1140870-overview. Updated 2007.
- Costa J, Evangelista T, Conceiçao I, de Carvalho M. Repetitive nerve stimulation in myasthenia gravis - relative sensitivity of different muscles. Clin Neurophysiol 2004; 115: 2776-2782.
Go to original source... 
Go to PubMed... - Katirji B. Electrodiagnosis of neuromuscular junction disorders In: Kaminski HJ (Ed). Myasthenia gravis and related disorders, 2nd ed, Humana Press: New York, 2009: 119-141. Go to original source...
- Martyn JAJ, Fagerlund MJ, Eriksson LI. Basic principles of neuromuscular transmission. Anaesthesia 2009; 64(Suppl. 1): 1-9. Go to original source... Go to PubMed...
- McConville J, Vincent A. Diseases of the neuromuscular junction. Curr Opin Pharmacol 2002; 2: 296-301. Go to original source... Go to PubMed...
- Nicolle MW. Myasthenia gravis. The Neurologist 2002; 8: 2-21. Go to original source... Go to PubMed...
- Niks EH, Badrising UA, Verschuuren JJ, van Dijk JG. Decremental response of the nasalis and hypothenar muscles in myasthenia gravis. Muscle Nerve 2003; 28: 236-238. Go to original source... Go to PubMed...
- Piťha J, Ambler Z. Myasthenia gravis. In: Neurologie 2003, Praha: Triton, 188-202.
- Shah AK. Myasthenia Gravis. Dostupný na http://emedicine.medscape.com/article/1171206-overview. Updated 2009.
- Shear TD, Martyn JAJ. Physiology and biology of neuromuscular transmission in health and disease. J Crit Care 2009; 24: 5-10. Go to original source... Go to PubMed...
- Stickler DE, Sanders DB. Lambert-Eaton Myasthenic Syndrome. Dostupný na http://emedicine.medscape.com/article/1170810-overview. Updated: 2009.
- Špalek P. Myasténia gravis. Ces Slov neurol N 2008; 71(104): 7-24.
- Trontelj JV, Sanders DB, St?lberg EV. Electrophysiological methods for assessing neuromuscular transmission. In: Brown WF, Bolton CF, Aminoff MJ (Eds.). Neuromuscular function and disease. Philadelphia: W. B. Saunders, 2002: 414-432.
- Ubogu EE, Ruff RL. Neuromuscular junction physiology and pathophysiology. In Kaminski HJ (Ed). Myasthenia gravis and related disorders, 2nd ed, Humana Press: New York, 2009: 1-12. Go to original source...
- Zinman LH, O'connor PW, Dadson KE, Leung RCM, Ngo M, Bril V. Sensitivity of repetitive facial-nerve stimulation in patients with myasthenia gravis. Muscle Nerve 2006; 33: 694-696. Go to original source... Go to PubMed...