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Contemporary diagnostics of neuro-muscular (n-m) transmission disorders (including myasthenia and myasthenic syndromes) comprises: (1) Pharmacological testing with edrophonium or neostigmine, (2) Immunological investigations of antibodies against AChR, MuSK and Ca channels, (3) Electrophysiological examinations: repetitive nerve stimulation (RNS) and electromyography of single muscle fibre (SFEMG) with jitter evaluation. When discussing the RNS, the physiological pathology of changes occurring during this test in the n-m junction is presented, as well as the effect of temperature on n-m transmission and the problem of n-m block selectivity. An optimal selection of muscles for such studies is proposed, taking into consideration that in n-m transmission disorders the sensitivity is higher in the proximal muscles than in the distal ones. Methods of activation of the changes looked for is discussed and an optimal investigation programme proposed. A typical myasthenic electrophysiological pattern is presented as well as that typical of Lambert-Eaton syndrome and congenital myasthenia. SFEMG method is discussed and its usefulness in diagnosing n-m transmission disturbancies. Finally, specificity and sensitivity of procedures employed in n-m transmission disturbancies is compared.
Hausmanowa-Petrusewicz, I., Rowińska-Marcińska, K„ Emeryk-Szajewska, B„ Ryniewicz, B„ Kopeć, A., Kopeć, J. and Szmidt-Saikowska E.: The diagnostic yield of automatic EMG analysis in neuromuscular diseases. Acta physiol, pol., 1988, 39 (1): 11—19. The aim of the study was to evaluate the diagnostic yield of automatic EMG analysis employed in differentiating normal from diseased muscle and myogenic, neural and spinal lesions. The material comprised 520 patients with neuromuscular diseases. Only diagnostically confirmed cases were included into the study. The control group comprised 51 healthy subjects. In all patients and healthy subjects routine EMG examination was performed by means of both the conventional technique and automatic method. On the basis of the statistical analysis of the material the authors concluded that the method of automated EMG using the Polish minicomputer Anops makes possible distinction of the main types of pathological processes affecting the muscles with higher than previously objectivity and reliability. They stress, however, the important role of the examiner and his experience.
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