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Laboratory Reference for Clinical Neurophysiology$
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Jay A. Liveson and Dong M. Ma

Print publication date: 1999

Print ISBN-13: 9780195129243

Published to Oxford Scholarship Online: March 2012

DOI: 10.1093/acprof:oso/9780195129243.001.0001

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Repetitive Nerve Stimulation Studies

Repetitive Nerve Stimulation Studies

(p.363) Chapter 18 Repetitive Nerve Stimulation Studies
Laboratory Reference for Clinical Neurophysiology

Jay A. Liveson

Dong M. Ma

Oxford University Press

The presynaptic region releases acetylcholine from an immediately available primary store and from a secondary store which can be easily mobilized. With each subsequent nerve impulse, the primary, immediately available store becomes progressively depleted. The secondary store starts to replenish the former, but only after a slight lag. Normally, this is not apparent because there is a safety factor: the nerve releases three times the effective acetylcholine dose. This may become apparent as impulses fail to discharge the muscle fibers effectively (blocking), causing a decrease in the motor response. At the optimal frequency (three hertz) for repetitive nerve stimulation, the primary store is maximally depleted while the secondary store mobilization is minimized. This is the basis of the response to rapid nerve stimulation leading to post-activation potentiation. Several minutes later this is followed by post-activation exhaustion, possibly because of depletion of the presynaptic stores.

Keywords:   presynaptic region, acetylcholine, primary store, secondary store, repetitive nerve stimulation, post-activation potentiation, post-activation exhaustion

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