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20. Late resp F H
- 1. Late responses & Reflexes F-wave Repeaters A-wave CMAP followers H-reflex T-wave Blink-reflex Flexion-reflex Interlimb reflex C-wave St奪lberg
- 2. Generator site for late responses; F-response Motor neurone Single motor axon Stimulation Recurrent response starting at first internode F-response; infrequent in various normal axons
- 6. number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.ulnaris 120 100 80 60 40 20 0 Std. Mean N = 1 number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.ulnaris 120 100 80 60 40 20 0 Std. Mean N = 1 number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.medianus 40 30 20 10 0 Std. Dev = 4,18 Mean = 15 N = 152,00 number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.medianus 40 30 20 10 0 Std. Dev = 4,18 Mean = 15 N = 152,00 Std.Dev = 4.18 Mean = 14.7 N = 152 Std.Dev = 3.31 Mean = 17.5 N = 196 Number of F-waves/20 stimuli in healthy subjectsNumber of F-waves/20 stimuli in healthy subjects Puuksa, Falck, St奪lberg unpubl Mean = 15,7, range 3-20, -2,5SD= 6 SD = 3,74 N= 482 Mean = 18,1; range 1-20, -2,5 SD 10,4 SD 3,08 N= 485
- 7. number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.peroneus 14 12 10 8 6 4 2 0 Std. Dev = 5,07 Mean = 10 N = 121,00 number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.peroneus 14 12 10 8 6 4 2 0 Std. Dev = 5,07 Mean = 10 N = 121,00 number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.tibialis 100 80 60 40 20 0 Std. Mean N = 1 number of F waves/20 stimuli 2019181716151413121110987654321 NERVE: n.tibialis 100 80 60 40 20 0 Std. Mean N = 1 Std.Dev = 2.89 Mean =18.4 N = 125 Std.Dev = 5.07 Mean = 10.1 N = 121 Number of F-waves/20 stimuli in healthy subjectsNumber of F-waves/20 stimuli in healthy subjects Puuksa, Falck, St奪lberg unpubl Mean 9,27, range 1-20, -2,5SD = 0 N= 221 Mean 18,04; range 1-20, -2,5SD= 8,84 N = 228
- 8. F-wave persistence in relation to CMAP ampl (control, ulnar nerve) mV # F/20 stim
- 9. F-waves diabetic neuropathy
- 10. N Peroneus F-waves - conduction blockF-waves - conduction block
- 11. F-waves - rhizopathyF-waves - rhizopathy
- 12. Late responsesLate responses (F-waves- H reflexes?)(F-waves- H reflexes?) in spasticityin spasticity
- 13. 10 ms 1 mV C6 radiculopathy, right side
- 14. C6 radiculopathy, right side
- 15. Left med Right uln Right med Left uln There are more F-waves on right side, central lesion
- 16. PLS - ALS 64185
- 17. PLS - ALS 64185
- 18. PLS - ALS 64185
- 19. PLS - ALS 64185
- 20. F-responses - normal CMAP n F ampl n F # n
- 21. F-responses - demyelination CMAP n F ampl n F # n
- 22. F-responses conduction block CMAP n F ampl n F # few
- 23. F-responses - normal CMAP n F ampl n F # n
- 24. F-responses axonal loss CMAP 50% F ampl n F # 50%
- 25. F-responses chronic neurogenic CMAP n F ampl 200% F # 50%
- 26. F-responses myopathic condition CMAP 50% F ampl 50% F # n
- 27. F-responses - spasticity CMAP n F ampl 200% F # 200% F dispersion
- 28. Generator site for late responses; A waves Motor neurone Single motor axon Stimulation Excitation of a hyperexcitable site A-wave; appears after each stimulus in an affected axon anywhere along the axon
- 29. A-waves (and repeater) N Medianus
- 30. Intermediate responses axon reflex extra discharge (IDD) ephaps M satellite
- 32. A-waves in a patient with Guillain Barr辿 syndromeA-waves in a patient with Guillain Barr辿 syndrome 15 year old girl
- 33. Other mecahnism for late responses; CMAP satellites Motor neurone Single motor axon Stimulation Slow conduction in distal axons
- 34. Moving stimulating electrode Double stimulation IDD and M-satellites - different pathophysiology IDD channel (K+ defect) CMAP-satellites, myelin and axon IDD and M-satellites can be differentiated
- 35. CMAP-satellites, terminal slowing PNP; Tib n. ankle and knee stim
- 36. 5 ms 5 mV A 1 mV 10 ms BUlnar nerve Peroneal nerve Cholinergic extradischarges (MUSK +) pronounced (A), slight (B)
- 37. 2 mV 5 ms 1 10 5 mV 5 ms pause Ulnar nerve (MuSK) Cholinergic extra discharges disappear at 3Hz stim 3 Hz 3 Hz
- 38. Congenital myasthenia (slow channel)(slow channel) St奪lberg
- 39. PEMD that remain on 3 Hz RNS PC, Short exercise Fournier et al, Ann Neurol. 2004
- 41. A B 101.2 97.5 97.5 133.8 146.2 216.2 1 mV / div 30 ms / div 0.1 mV / div 30 ms / div Long latency responses in prior polio Interlimb reflex (ILR) from VL at ipsilat plexus stim Startle response from VL at contralat plexus stim
- 42. latency after CMAP type immediate intermed late not relaxed,submax stim x extra discharges x myotonic discharges(PEMD) x A-waves x x (x) CMAP-satellites x x (x) F-waves x H-reflex x flexion reflexes x ILR x C-waves x Late components after the CMAP Erik St奪lberg, Uppsala Sweden