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Repetitive CMAPs: Mechanisms of neural and synaptic genesis

✍ Scribed by J. Gert van Dijk; Gert Jan Lammers; Axel R. Wintzen; Peter C. Molenaar

Publisher: John Wiley and Sons
Year: 1996
Tongue: English
Weight: 673 KB
Volume: 19
Category: Article
ISSN: 0148-639X
DOI: 10.1002/(sici)1097-4598(199609)19:9<1127::aid-mus7>3.0.co;2-1

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✦ Synopsis

Repetitive compound muscle action potentials (R-CMAPs) occur when a single nerve shock excites muscle fibers repeatedly. "Double discharges" are due to intramuscular nerve reexcitation. "Synaptic" R-CMAPs, due to excess acetylcholine in the neuromuscular synapse, can occur in congenital myasthenia, the slow-channel syndrome, and acetylcholinesterase inhibition. Secondary nerve excitation can reexcite muscle fibers. Synaptic R-CMAPs in a patient consisted of two discharges. The second diminished during repetitive stimulation and began 3.5-4.0 ms after the first, which is slightly longer than the synapse-muscle refractory period. Neural R-CMAPs, due to ectopic nerve activity, occur in neuromyotonia (NMT). R-CMAPs in a patient consisted of about 20 discharges at 200-300 Hz. Studies in healthy subjects showed that such trains represent added single CMAPs. Impulse frequency in the patient lied close to the threshold of refractoriness. Refractoriness of the synapse-muscle cell assembly determines the characteristics of R-CMAPs regardless of the primary cause.

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