{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T13:06:14Z","timestamp":1793711174312,"version":"4.6.1"},"reference-count":72,"publisher":"Georg Thieme Verlag KG","issue":"12","license":[{"start":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T00:00:00Z","timestamp":1703808000000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The nerve terminal and muscle membrane compose the neuromuscular junction. After opening the voltage-gated calcium channels, action potentials from the motor axons provoke a cascade for the acetylcholine release from synaptic vesicles to the synaptic cleft, where it binds to its receptor at the muscle membrane for depolarization. Low amplitude compound muscle action potential typically presents in presynaptic disorders, increasing by more than 100% after a 10-second effort in the Lambert-Eaton myasthenic syndrome and less in botulism. Needle electromyography may show myopathic motor unit action potentials and morphological instability (\u201cjiggle\u201d) due to impulse blocking. Low-frequency repetitive nerve stimulation (RNS) is helpful in postsynaptic disorders, such as myasthenia gravis and most congenital myasthenic syndromes, where the number of functioning acetylcholine receptors is reduced. Low-frequency RNS with a decrement &gt;10% is abnormal when comparing the 4th to the first compound muscle action potential amplitude. High-frequency RNS is helpful in presynaptic disorders like Lambert-Eaton myasthenic syndrome, botulism, and some rare congenital myasthenic syndromes. The high-frequency RNS releases more calcium, increasing the acetylcholine with a compound muscle action potential increment. Concentric needle records apparent single-fiber action potentials (spikes). A voluntary activation measures the jitter between spikes from two endplates. An electrical activation measures the jitter of one spike (one endplate). The jitter is the most sensitive test for detecting a neuromuscular junction dysfunction. Most neuromuscular junction disorders are responsive to treatment.<\/jats:p>","DOI":"10.1055\/s-0043-1777749","type":"journal-article","created":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:05:43Z","timestamp":1703894743000},"page":"1040-1052","source":"Crossref","is-referenced-by-count":10,"title":["Electrophysiological evaluation of the neuromuscular junction: a brief review"],"prefix":"10.1055","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9384-9964","authenticated-orcid":false,"given":"Jo\u00e3o Aris","family":"Kouyoumdjian","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto, Departamento de Ci\u00eancias Neurol\u00f3gicas, Psiquiatria e Psicologia M\u00e9dica, S\u00e3o Jos\u00e9 do Rio Preto SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6807-1951","authenticated-orcid":false,"given":"Eduardo de Paula","family":"Estephan","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto, Departamento de Ci\u00eancias Neurol\u00f3gicas, Psiquiatria e Psicologia M\u00e9dica, S\u00e3o Jos\u00e9 do Rio Preto SP, Brazil."},{"name":"Universidade de S\u00e3o Paulo, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."},{"name":"Faculdade de Medicina Santa Marcelina, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,12,29]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1113\/jphysiol.1975.sp011103","article-title":"The number of transmitter molecules in a quantum: an estimate from iontophoretic application of acetylcholine at the neuromuscular synapse","volume":"251","author":"S W Kuffler","year":"1975","journal-title":"J Physiol"},{"issue":"03","key":"ref2","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1113\/jphysiol.1951.sp004675","article-title":"An analysis of the end-plate potential recorded with an intracellular electrode","volume":"115","author":"P Fatt","year":"1951","journal-title":"J Physiol"},{"issue":"06","key":"ref3","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1002\/mus.22177","article-title":"Endplate contributions to the safety factor for neuromuscular transmission","volume":"44","author":"R L Ruff","year":"2011","journal-title":"Muscle Nerve"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"8S","DOI":"10.1212\/WNL.48.Suppl_5.8S","article-title":"Neuromuscular junction physiology in myasthenia gravis Isoforms of the acetylcholine receptor in extraocular muscle and the contribution of sodium channels to the safety factor","volume":"48","author":"H J Kaminski","year":"1997","journal-title":"Neurology"},{"issue":"07","key":"ref5","doi-asserted-by":"publisher","first-page":"2818","DOI":"10.1073\/pnas.71.7.2818","article-title":"The density of acetylcholine receptors and their sensitivity in the postsynaptic membrane of muscle endplates","volume":"71","author":"E X Albuquerque","year":"1974","journal-title":"Proc Natl Acad Sci U S A"},{"key":"ref6","volume-title":"Chapter 2: Reliability of neuromuscular transmission and how it is maintained","author":"C R Slater","year":"2008"},{"issue":"04","key":"ref7","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/s0301-0082(00)00055-1","article-title":"Safety factor at the neuromuscular junction","volume":"64","author":"S J Wood","year":"2001","journal-title":"Prog Neurobiol"},{"issue":"05","key":"ref8","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1002\/mus.24300","article-title":"Neuromuscular junction disorders mimicking myopathy","volume":"50","author":"P C Mongiovi","year":"2014","journal-title":"Muscle Nerve"},{"issue":"09","key":"ref9","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1002\/mus.1139","article-title":"Practice parameter for repetitive nerve stimulation and single fiber EMG evaluation of adults with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome: summary statement","volume":"24","author":"AAEM Quality Assurance Committee. 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