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Results for “Neuromuscular Junction Diseases”

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At least 19 recordsLinked to original sources
PubMed1982

Electrophysiology of neuromuscular junction disease: an appreciation of the contributions of Edward H. Lambert.

As the muscle fiber action potential is "all or none" and is not of constant voltage recorded in volume from remote electrodes, there are serious limitations on assessment of the "safety factor" for neuromuscular transmission by stimulus-response recording from surface electrodes, or by single fiber EMG. Lambert's use of biopsied intercostal muscle with microelectrode recording of spontaneous and evoked end-plate potentials has permitted more accurate analysis of transmission disorders. His personal and collaborative studies on experimental myasthenia gravis, congenital myasthenic syndromes, amyotrophic lateral sclerosis, and the Lambert-Eaton myasthenic syndrome are reviewed. It is suggested that studies of acetylcholine receptor agonists require reevaluation as indicating inadequacies of present models.

Carcinoma, Bronchogenic↗
PubMed2005

Neuromuscular junction autoimmune disease: muscle specific kinase antibodies and treatments for myasthenia gravis.

PURPOSE OF REVIEW: Some of the 20% of myasthenia gravis patients who do not have antibodies to acetylcholine receptors (AChRs) have antibodies to muscle specific kinase (MuSK), but a full understanding of their frequency, the associated clinical phenotype and the mechanisms of action of the antibodies has not yet been achieved. Moreover, some patients do not respond well to conventional corticosteroid therapy. Here we review recent clinical and experimental studies on MuSK antibody associated myasthenia gravis, and summarize the results of newer treatments for myasthenia gravis. RECENT FINDINGS: MuSK antibodies are found in a variable proportion of AChR antibody negative myasthenia gravis patients who are often, but not exclusively, young adult females, with bulbar, neck, or respiratory muscle weakness. The thymus histology is normal or only very mildly abnormal. Surprisingly, limb or intercostal muscle biopsies exhibit no reduction in AChR numbers or complement deposition. However, patients without AChR or MuSK antibodies appear to be similar to those with AChR antibodies and may have low-affinity AChR antibodies. A variety of treatments, often intended to enable corticosteroid doses to be reduced, have been used in all types of myasthenia gravis with some success, but they have not been subjected to randomized clinical trials. SUMMARY: MuSK antibodies define a form of myasthenia gravis that can be difficult to diagnose, can be life threatening and may require additional treatments. An improved AChR antibody assay may be helpful in patients without AChR or MuSK antibodies. Clinical trials of drugs in other neuroimmunological diseases may help to guide the treatment of myasthenia gravis.

Autoantibodies↗
PubMed2003

Neuropathology considerations: clinical and SEMG/biofeedback applications.

SEMG investigation protocols are described within the neurological framework. A neuroanatomic pathway is utilized including muscular disease, neuromuscular junction conditions, peripheral neuropathy, radiculopahy, myleopathy, brainstem disorders, cerebellar disorders, subcortical and cortical disease. SEMG findings within the clinical presentation of those pathologies are aimed at improving the diagnostic process and serve to focus the SEMG neuromuscular reeducation (biofeedback) component of the overall treatment plan.

Animals↗
PubMed2004

Congenital diseases of feline muscle and neuromuscular junction.

Although muscle diseases occur relatively rarely in cats, a number of congenital feline myopathies have been described over the last 20 years and are reviewed in this paper. Some of them have been reported exclusively in specific breeds, including the hypokalaemic myopathy of Burmese cats, type IV glycogen storage disease in Norwegian Forest cats, or the myopathy of Devon Rex. Other congenital disorders of muscle and neuromuscular junction such as myotonia congenita, dystrophin-deficient hypertrophic feline muscular dystrophy, laminin alpha2 deficiency, or congenital myasthenia gravis may occur in any cat. A systematic approach is essential in order to efficiently obtain a timely diagnosis in cats showing signs of muscle disease. After a thorough clinical examination, this approach includes blood analyses (eg, serum concentration of muscle enzymes), electrophysiology where available (electromyography, nerve conduction studies), and sampling of muscle biopsies for histological, histochemical and immunohistochemical evaluation. When available, detection of healthy carriers of these genetic disorders is important to eliminate the gene mutations from breeding families. Clinicians regularly receiving feline patients must have a good knowledge of congenital feline myopathies and the features which enable a diagnosis to be made and prognosis given. Besides preserving or restoring the well-being of the myopathic patient, rapid and efficient information and counselling of the breeders are of central importance in order to prevent the recurrence of the problem in specific breeding lines.

Animals↗
PubMedDate not supplied

Disorders of neuromuscular transmission other than myasthenia gravis.

Disorders of neuromuscular transmission in humans are caused by a wide variety of agents including systemic diseases, drugs, environmental toxins, animal envenomation, cations, and hormones. Some are genetically determined. Many are of known etiology. All such disorders interfere with one or more events in the sequence whereby a nerve impulse excites a muscle action potential. In many disorders of neuromuscular transmission, abnormal fatigue occurs, and some cases respond dramatically to treatment. Investigation of the microphysiology, microanatomy, and pharmacology of both normal and diseased neuromuscular junctions has increased our knowledge of these disorders.

Action Potentials↗
PubMed2005

The value of basic science in clinical diagnosis: creating coherence among signs and symptoms.

BACKGROUND: We investigated whether learning basic science mechanisms may have mnemonic value in helping students remember signs and symptoms, in comparison with learning the relation between symptoms and diagnoses directly. PURPOSE: To compare 2 approaches to learning diagnosis: learning how features of various conditions relate to underlying pathophysiological mechanisms and learning the conditional probabilities of features and diseases. METHODS: Undergraduate students (n = 36) were taught 4 disorders (upper motor neuron lesion, lower motor neuron lesion, neuromuscular junction disease and muscular disease), either using basic science explanations or (symptom x disease) probabilities. They were tested with diagnostic cases immediately after learning and 1 week later. RESULTS: On the immediate test, there was no difference in the results. One week later, the accuracy of the mechanism group remained at 0.52, but the performance of the probability group had dropped to 0.43. CONCLUSIONS: Knowledge of basic science may have value in clinical diagnosis by helping students recall or reconstruct the relationships between features and diagnoses.

Clinical Competence↗
PubMed1987

Neurological manifestations of the post-polio syndrome.

Patients with late effects of poliomyelitis, i.e., PPS, are being seen at an ever increasing frequency by general physicians, neurologists, and orthopedists. An appropriate time interval for the onset of late manifestations has elapsed since the major epidemics of poliomyelitis in the 1940s and 1950s. Post-polio neurological manifestations primarily include new weakness, atrophy, muscle pain, and fasciculations. Fortunately, the weakness is of a very slow, progressive nature. Abnormal laboratory studies include routine EMG, demonstrating chronic denervation; SFEMG, demonstrating increased fiber density, increased jitter, and blocking; and muscle biopsy most often revealing fiber-type grouping of chronic denervation and small isolated angular (or angulated) fibers and group atrophy in some series, both suggestive of active denervation. Unfortunately, both EMG and muscle biopsy studies suffer from a lack of specificity as they do not appear to distinguish asymptomatic from symptomatic (new weakness, PPMA) patients with prior poliomyelitis. Although the cause of PPMA is unknown, electrophysiological (SFEMG) and muscle biopsy studies suggest that the process involves a loss or dropout of axon terminals of reinnervated motor units. The axons terminal dropout could be due to dysfunction in the cell soma, the axon, or the terminals themselves. Whether motor neuron exhaustion, a persistent viral infection, or immune-mediated mechanisms play a role in the pathogenesis of the late weakness is unclear at present and will require further investigation. Treatment at this time is of a supportive nature. A major controversy involves the role of strengthening exercises in these patients since experimental animal studies suggest that excessive exercise of denervated muscles leads to increased weakness. Clearly, a better understanding of PPS and PPMA will allow more effective management of these patients' problems and might also provide insight into other motor neuron and neuromuscular junction diseases.

Aging↗
PubMed1998

Electrodiagnosis in neuromuscular disease.

This article provides a general approach to the electrodiagnostic evaluation of the patient with neuromuscular disease. The electrodiagnostic findings in patients with various forms of peripheral neuropathy, motor neuron disease, neuromuscular junction disorders, and myopathy are presented. The pediatric electrodiagnostic evaluation is also discussed.

Adult↗
PubMed2003

The role of readthrough acetylcholinesterase in the pathophysiology of myasthenia gravis.

Alternative splicing induces, under abnormal cholinergic neurotransmission, overproduction of the rare "readthrough" acetylcholinesterase variant AChE-R. We explored the pathophysiological relevance of this phenomenon in patients with myasthenia gravis (MG) and rats with experimental autoimmune MG (EAMG), neuromuscular junction diseases with depleted acetylcholine receptors. In MG and EAMG, we detected serum AChE-R accumulation. In EAMG, we alleviated electromyographic abnormalities by nanomolar doses of EN101, an antisense oligonucleotide that selectively lowers AChE-R in blood and muscle yet leaves unaffected the synaptic variant AChE-S. Whereas animals treated with placebo or conventional anticholinesterases continued to deteriorate, a 4 wk daily oral administration of EN101 improved survival, neuromuscular strength and clinical status in moribund EAMG rats. The efficacy of targeting only one AChE splicing variant highlights potential advantages of mRNA-targeted therapeutics for chronic cholinergic malfunctioning.

Acetylcholinesterase↗
PubMed1999

Organ-specific autoantibodies with muscle weakness.

The motor unit includes the anterior horn cell, the motor axon and the muscle fibers it innervates, and the neuromuscular junction. Diseases of the motor unit usually present with weakness. Diagnosis of motor unit disorders involves the history, physical examination, electrophysiologic studies of nerve and muscle, and blood testing for creatine kinase, genetic disorders, and autoantibodies. Antibody testing is often useful for the identification of specific immune-mediated motor unit disorders. Identification of these disorders is important because they are often treatable. Antibodies with disease specificity include those directed against autoantigens with and without organ specificity. Several autoantibodies to non-organ-specific antigens are associated with subgroups of immune myopathies. Organ-specific autoantibodies in motor unit disorders with weakness occur in myasthenia gravis, especially with thymoma, a myopathy associated with Waldenstrom's macroglobulinemia, Lambert-Eaton myasthenic syndrome, and multifocal motor neuropathy.

Autoantibodies↗
PubMed2004

Alzheimer's amyloid-beta (A beta) is an essential synaptic protein, not neurotoxic junk.

Despite a decade long universal publication in favor of the view on amyloid-beta (A beta) as Alzheimer's disease culprit (solely neurotoxic for neurons and brain tissue), current scientific evidence leaves little doubt that A beta serves an essential role at synapse and in synaptic structure-functional plasticity that underlie learning and memory. Therefore, the change of A beta biology in Alzheimer's disease (as well as in a number of other human pathologies, including cardiovascular disease, neuromuscular junction disorders, NPC and Down's syndrome) may represent a physiological mechanism to compensate for impaired brain structure or function. In our own recent study A beta 1-40 rescued long term potentiation (LTP, a major model for activity-dependent CNS plasticity), while cholesterol synthesis inhibition abolished the restorative action of the A beta peptide. This study confirms that A beta protein is a functional player in synaptic structure-functional plasticity and in cholesterol neurochemical pathways. The article also calls for a need to critically re-evaluate a universal belief that transgenic mice with a transgene for amyloid-beta protein precursor (A beta PP) are a true model for Alzheimer's type neurodegeneration.

Alzheimer Disease↗
PubMed2000

Acute care pediatric electromyography.

The recognition of uncommon pediatric motor unit disorders or unusual clinical presentations of common illnesses, such as Guillain-Barré syndrome (GBS), have increased the need for electromyography (EMG) in childhood critical care units. There are two different clinical sets, one appropriate to newborns and infants and the other to older children. Some illnesses that present as an acute floppy infant are not found in the differential diagnosis of motor unit disorders in the older child or adult. These include spinal muscular atrophy, postvaccine poliomyelitis, intrauterine GBS, infantile botulism, and severe myopathies, such as myotonia dystrophy, and some glycogen storage diseases. An appreciation of the neurophysiological maturational norms is essential to an effective pediatric EMG consultation for children ages 0-3 years. Additionally, the neuromuscular complications of extended intubation and sepsis in children are gaining broader recognition. An increased dialogue between clinical neurophysiologists and pediatric neurologists and intensivists in both neonatal and pediatric intensive care units is essential.

Acute Disease↗
PubMed1998

Binocular vertical diplopia.

The assessment of a patient with binocular vertical diplopia begins with a thorough history and neuro-ophthalmologic examination. The neuro-ophthalmologic examination includes observation for a compensatory head, face, or chin position; ocular ductions and versions in the nine cardinal positions of gaze; the three-step test; the double Maddox rod test; indirect ophthalmoscopy to observe the location of the fovea in relationship to the optic nerve head to determine cyclodeviation; and the forced ductions test. Binocular vertical diplopia may be due to supranuclear processes, ocular motor nerve dysfunction, neuromuscular junction disease, diseases of eye muscle, mechanical processes causing vertical eye misalignment, and even retinal disease. In this article, the differential diagnosis of these processes is outlined.

Diplopia↗