2022 Workshop Handout Bundle-Repetitive Nerve Stimulation

Repetitive Nerve Stimulation

Pdf Summary

The document is a workshop handout on repetitive nerve stimulation (RNS) presented by Dr. Taylor Harrison. The handout provides an overview of normal neuromuscular junction physiology and the role of RNS in evaluating neuromuscular disorders. It discusses the anatomy and function of motor units, the release of acetylcholine at the neuromuscular junction, and the generation of muscle fiber action potentials. The handout also explores the concept of the safety factor, which is the difference between the size of an end plate potential and the threshold for generating a muscle fiber action potential. It explains how reduced safety factor can contribute to clinical signs and symptoms in neuromuscular transmission disorders like myasthenia gravis.<br /><br />The handout then delves into specific diseases and their impact on neuromuscular transmission. It describes the pathogenic mechanisms in myasthenia gravis, including the presence of autoantibodies that affect the acetylcholine receptors and decrease the safety factor. It also mentions Lambert-Eaton myasthenic syndrome and botulism as other pre-synaptic disorders that affect neuromuscular transmission.<br /><br />The handout provides guidelines for performing RNS, including the choice of nerve-muscle pairs for stimulation, the use of supramaximal stimulation to avoid false positives, and the importance of limb immobilization to reduce movement artifacts. It explains how RNS can be used to diagnose myasthenia gravis, Lambert-Eaton myasthenic syndrome, and botulism. It describes the patterns of decrement and increment observed in these diseases, as well as the use of post-exercise facilitation to differentiate certain disorders.<br /><br />The handout concludes with recommendations for reporting RNS results, including information on stimulation parameters, muscle state, calculation methods, and medication that might impact neuromuscular junction transmission. It emphasizes the importance of including waveforms in the report for quality assessment.<br /><br />Overall, the workshop handout serves as an educational resource for healthcare professionals interested in understanding and utilizing repetitive nerve stimulation in the evaluation of neuromuscular disorders.

Keywords

repetitive nerve stimulation

neuromuscular junction physiology

RNS

neuromuscular disorders

motor units

acetylcholine

safety factor

myasthenia gravis

Lambert-Eaton myasthenic syndrome

botulism