Hello, I am Aziz Shaybani. I am a neuromuscular specialist from Houston, Texas. I am going to talk today about the phenomenon of facilitation in neuromuscular medicine. What is exercise facilitation? It is a characteristic feature of Lambert-Eaton syndrome. Simply, it means increased strength of the tested muscle and or enhanced deep tendon reflexes after sustained muscle contraction, in particular after a brief period of rest. Pathophysiologically, this is caused by the presence of antibodies against the voltage-gated calcium channels in the presynaptic terminals. This is the channel that is blocked by the antibodies. Therefore, calcium will not influx to the terminal and acetylcholine is not released. Here is a video to demonstrate facilitation. Mr. Shaybani gets stronger to demonstrate that the reflexes are regained by exercise. or elapsed it's there right after an exercise the video has demonstrated facilitation of the left patellar reflex after a brief exercise and it demonstrated facilitation of the strength of the tested muscles after exercise this is an important feature of post-synaptic neuromuscular transmission disorder post-exercise facilitation and an incremental response after high-frequency stimulation share the same mentioned pathophysiology usually facilitation is noticed in several muscles and patients with limbs the degree of facilitation is important diagnostically if facilitation is noticed in one muscle greater than 400% the patient almost certainly has limbs or facilitation is greater than 100% in several tested muscles however facilitation more than 50% is only suggestive of limbs and it can happen also in myasthenia gravis a couple of studies have shown that the optimal duration of exercise is 10 seconds teachable moments are number one check for clinical and electrical facilitation in all patients with myopathy in particular when the c-map amps are diffusely low two the optimal exercise is 10 seconds of sustained muscle contraction of the selected muscle thank you

neuromuscular medicine

Lambert-Eaton syndrome

exercise facilitation

voltage-gated calcium channels

myopathy assessment