#Neuromuscular 

My pleasure!

+Ramiro Duran Hi Ramiro, thank you for the questions. It seems that the repetitive nerve stimulation used to be referred to as the Jolly test, but I have never come across that terminology before, so thank you. Yes, it should ideally be performed on weak muscles and I often test around nasalis or orbicularis oculi as well as APB (and of course perform SF-EMG) . The benefit is in terms of subsequent follow up, as patients don't always appreciate having single fiber studies performed each time. Bw Simon

Hi Juan, when jitter is being measured we are looking only at the differences in the timing of the pairs, not their amplitude. In fact we need to make sure that the amplitudes are stable during the measurement window otherwise its very difficult to obtain accurate results. We do look at amplitudes during Repetitive Stimulation studies which reflect the summation of many muscle fibre potentials and their dropout as NMJ Transmission fails. Hope this helps and best wishes, Simon

Thanks so much! Excellent videos!!! =D

Excellent! I am trying to learn SFEMG. So please give more videos on this. Thanks Selina Daisy.

Syeda Zeba Khakashan g

Hi, yes you can test most muscles but there are various issues and this will be a bit technical. The first is finding normative data for rarely tested muscles. However, if there's significant jitter that isn't such an issue. But if there is significant jitter then you're quite likely to find it else too, and have proper normative data for those muscles, and so there's little to be gained. Anther issue is maintaining smooth muscle activation for prolonged periods in muscles which take a lot of weight, and there's also a potential safety issue around needling close to the lungs. So all in all, not muscles I'd particularly go for. Relatively simple to do repetitive nerve testing of the trapezius but it's not comfortable and often needs repeating due to technical constraints and muscle shortening. Hope that helps, bw Simon

In England we also can't afford them either! We use the standard facial concentric needles which yield good and dependable results (30G) , and have a solid evidence base behind them. Best wishes, Simon

Then we must change machine standard settings if we use such needles ?

Sadok Hamza Yes, the low pass filters need to be changed

Keypoint.Net Its effectively proprietary to the hardware though (Dantec Keypoint G4) Bw Simon

@@DrSimonFreilich thank you, im always curious about the software my doctors use when they check me hah, they made a lot of exams on me, one more painful than the other. The Single Fiber EMG shows abnormal jitter and nowadays get treated for myasthenia gravis