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Repetitive Nerve Stimulation
Plan of the talk ,[object Object],[object Object],[object Object],[object Object]
 
 
definitions ,[object Object],[object Object],[object Object],[object Object],[object Object]
definitions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Calcium and quanta dynamics ,[object Object],[object Object],[object Object],[object Object]
Potentiation ,[object Object],[object Object],[object Object],[object Object]
 
Relationship -EPP,AP,CMAP
Neuromuscular   junction disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Repetitive nerve stimulation ( RNS) ,[object Object],[object Object],[object Object]
RNS- technique ,[object Object],[object Object],[object Object],[object Object]
RNS-technique ,[object Object],[object Object],[object Object],[object Object]
Muscle selection ,[object Object],[object Object],[object Object],[object Object]
Machine setup for RNS 30-50 Stimulus rate -high <5 Stimulus rate -low 0.1 Stimulus duration (msec) 2-3 High filter (KHz) 2-5 Low filter (Hz) 2 Sweep time (ms/div) 2-5 Sensitivity (mV/div)
temperature ,[object Object],[object Object],[object Object],[object Object]
Effect of temperature on RNS
Stimulus technique ,[object Object],[object Object],[object Object],[object Object]
Effect of different stimulation rates
Activation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Measurement technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Slow RNS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Slow RNS
Rapid RNS ,[object Object],[object Object],[object Object],[object Object]
Rapid RNS
Patterns of response to slow RNS
Activation cycle in MG
Criteria for abnormal decrement ,[object Object],[object Object],[object Object],[object Object],[object Object]
RNS in pre and post synaptic disorders Decrement or normal Increment  High rate RNS Decrement Present Present  Decrement  Present  Absent ,[object Object],[object Object],[object Object],[object Object],Normal  Small  CMAP amplitude Post-synaptic   Pre-synaptic   Parameter
Double step  RNS   ,[object Object],[object Object],[object Object],[object Object]
Regional curare test ,[object Object],[object Object],[object Object],[object Object],[object Object]
SFEMG
Jitter and block
Myasthenia gravis
Electrophysiological investigation   ,[object Object],[object Object],[object Object],[object Object]
RNS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Baseline and 10sec exercise
60sec exercise-exhaustion
Congenital Myasthenic Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Repetitive CMAP
Lambert Eaton Myasthenic Syndrome (LEMS ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LEMS
LEMS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Incrementing response after brief exercise (10-15 sec) in LEMS. Increment is 10-fold, with CMAP of 3.2 mV. CP CMAP amplitude is 0.35 mV (normal >1 mV).
Incremental response in LEMS
50hz RNS-increments
Botulism   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Botulism ,[object Object],[object Object],[object Object],[object Object]
Miscellaneous conditions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you

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repetitive nerve stimulation