Related Experiment Video
Updated: Jun 17, 2025
Open-Source Real-Time Closed-Loop Electrical Threshold Tracking for Translational Pain Research
Published on: April 21, 2023
The speed of completion of the decremental responses on repetitive nerve stimulation
Yuki Ueta1,2, Takamichi Kanbayashi2, Yosuke Miyaji2,3
1Department of Neurology, Tokyo Medical University Hachioji Medical Center, Tate-machi 1163, Hachioji, Tokyo 1930998, Japan.
Objective:
It is generally believed that the decremental response in repetitive nerve stimulation (RNS) stabilizes at the fourth or fifth response. We have a preliminary impression that the decremental response approaches a plateau earlier in proximal muscles than in distal muscles. We investigated the speed of the completion of the decremental response in different muscles.
Methods:
The "decrement completion ratio (DCR)" in the second or third response (DCR2 or DCR3) was defined as the ratio of the decremental percentage of the second or third response to that of the fourth response. Patients showing more than 10% decremental response both in the abductor pollicis (APB) and deltoid muscles were retrospectively extracted from our EMG database. The DCR2 and DCR3 were compared between two muscles in patients with myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS).
Results:
Identified subjects consisted of 11patients with MG and 11 patients with ALS. Multiple regression analysis revealed that only the difference of muscle influenced on DCR2 and DCR3, with no contribution from the different disorder (MG or ALS) or the initial amplitude of the compound muscle action potential (CMAP). Both DCR2 and DCR3 were significantly higher in deltoid than in APB. In ALS, the normalized CMAP amplitude was not different between APB and deltoid whereas the decremental percentage was significantly higher in deltoid, suggesting a lower safety factor of the neuromuscular transmission in proximal muscles.
Conclusions:
The decremental response completed more rapidly in deltoid than in APB which may be related to the lower safety factor also documented by this study.
Significance:
Unexpected early completion of the decrement such as at the second response in RNS is not a technical error but may be an extreme of the rapid completion in deltoid, a proximal muscle.
