Repetitive response

REPETITIVE RESPONSE TO SINGLE STIMULATION

Differential diagnosis

from M. Al-Lozi

Two CMAPs after single stimulus

Second CMAP (Arrow)
- Smaller than the first
- Follows first CMAP with consistent latency: Independent of site of nerve stimulation
Due to prolonged action of acetylcholine at neuromuscular junctions
Occurs with
- Congenital Myasthenic Syndromes
  - Slow AChR channel syndromes
  - AChE deficiency
- Acetylcholinesterase inhibition
  - Toxins
  - AChE inhibitor overdose (Cholinergic crisis)
- Oxaliplatin PN: Acute

from M. Al-Lozi

Repetitive (Second) response to individual stimuli (Arrows)
Amplitude of 2nd response is progressively reduced after repetitive nerve stimulation (10 Hz above)
No decrement in primary CMAP amplitude

from M. Al-Lozi

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2/27/2023