Thanks for your explanations, quich are very clear. I just need to ask whether jitter is thus defined as an isolated difference in response time or if it also implies that action potentials necessarily have a different amplitude.
Hi Juan, when jitter is being measured we are looking only at the differences in the timing of the pairs, not their amplitude. In fact we need to make sure that the amplitudes are stable during the measurement window otherwise its very difficult to obtain accurate results. We do look at amplitudes during Repetitive Stimulation studies which reflect the summation of many muscle fibre potentials and their dropout as NMJ Transmission fails. Hope this helps and best wishes, Simon
Hi, yes you can test most muscles but there are various issues and this will be a bit technical. The first is finding normative data for rarely tested muscles. However, if there's significant jitter that isn't such an issue. But if there is significant jitter then you're quite likely to find it else too, and have proper normative data for those muscles, and so there's little to be gained. Anther issue is maintaining smooth muscle activation for prolonged periods in muscles which take a lot of weight, and there's also a potential safety issue around needling close to the lungs. So all in all, not muscles I'd particularly go for. Relatively simple to do repetitive nerve testing of the trapezius but it's not comfortable and often needs repeating due to technical constraints and muscle shortening. Hope that helps, bw Simon
Mr. Freilich, Thanks for sharing this useful video. I would like to ask, is all this criteria also applicable to the Jolly test. May it be the same? And for MG is this test done around the eye lid muscles? Thank you so much!
+Ramiro Duran Hi Ramiro, thank you for the questions. It seems that the repetitive nerve stimulation used to be referred to as the Jolly test, but I have never come across that terminology before, so thank you. Yes, it should ideally be performed on weak muscles and I often test around nasalis or orbicularis oculi as well as APB (and of course perform SF-EMG) . The benefit is in terms of subsequent follow up, as patients don't always appreciate having single fiber studies performed each time. Bw Simon
Hello doctor simon shalom im from morocco im living with a case for 1 year and 6 month now im doing bodybuilding and lifting weights one time go i slept and i woke up with very relaxed smooth muscles i cant feel any pain when i go to gym my muscles became numb my legs muscles too smoth and relaxed i feel my respiration too smooth and relaxed . All my body shaking when i lift weight . I dont know what this case and until now im still lifting hevy weights but i feel my body numb and out of sense ☹️☹️
In England we also can't afford them either! We use the standard facial concentric needles which yield good and dependable results (30G) , and have a solid evidence base behind them. Best wishes, Simon
@@DrSimonFreilich thank you, im always curious about the software my doctors use when they check me hah, they made a lot of exams on me, one more painful than the other. The Single Fiber EMG shows abnormal jitter and nowadays get treated for myasthenia gravis
Better than 10 pages textbook. Thank you very much!
My pleasure!
Thank you for all your videos!!!
Thank you for demonstrations
Excellent explanation. Thank you!
thank you sir your videos help me a lot and your way of explanation is very good very awesome.
Syeda Zeba Khakashan g
Thanks for your explanations, quich are very clear. I just need to ask whether jitter is thus defined as an isolated difference in response time or if it also implies that action potentials necessarily have a different amplitude.
Hi Juan, when jitter is being measured we are looking only at the differences in the timing of the pairs, not their amplitude. In fact we need to make sure that the amplitudes are stable during the measurement window otherwise its very difficult to obtain accurate results.
We do look at amplitudes during Repetitive Stimulation studies which reflect the summation of many muscle fibre potentials and their dropout as NMJ Transmission fails.
Hope this helps and best wishes, Simon
Thanks so much! Excellent videos!!! =D
Excellent! I am trying to learn SFEMG. So please give more videos on this. Thanks
Selina Daisy.
Thanks for the video. Can you perform this test on the levator scapula and upper trapezius?
Hi, yes you can test most muscles but there are various issues and this will be a bit technical. The first is finding normative data for rarely tested muscles. However, if there's significant jitter that isn't such an issue. But if there is significant jitter then you're quite likely to find it else too, and have proper normative data for those muscles, and so there's little to be gained. Anther issue is maintaining smooth muscle activation for prolonged periods in muscles which take a lot of weight, and there's also a potential safety issue around needling close to the lungs. So all in all, not muscles I'd particularly go for. Relatively simple to do repetitive nerve testing of the trapezius but it's not comfortable and often needs repeating due to technical constraints and muscle shortening. Hope that helps, bw Simon
Mr. Freilich, Thanks for sharing this useful video. I would like to ask, is all this criteria also applicable to the Jolly test. May it be the same? And for MG is this test done around the eye lid muscles? Thank you so much!
+Ramiro Duran
Hi Ramiro, thank you for the questions. It seems that the repetitive nerve stimulation used to be referred to as the Jolly test, but I have never come across that terminology before, so thank you. Yes, it should ideally be performed on weak muscles and I often test around nasalis or orbicularis oculi as well as APB (and of course perform SF-EMG) . The benefit is in terms of subsequent follow up, as patients don't always appreciate having single fiber studies performed each time. Bw Simon
Hello doctor simon shalom im from morocco im living with a case for 1 year and 6 month now im doing bodybuilding and lifting weights one time go i slept and i woke up with very relaxed smooth muscles i cant feel any pain when i go to gym my muscles became numb my legs muscles too smoth and relaxed i feel my respiration too smooth and relaxed . All my body shaking when i lift weight . I dont know what this case and until now im still lifting hevy weights but i feel my body numb and out of sense ☹️☹️
thanks a lot dear freind here in Algeria we cant provide the special needle to execute SFEMG can we do it with usual coaxial needles ?
In England we also can't afford them either! We use the standard facial concentric needles which yield good and dependable results (30G) , and have a solid evidence base behind them. Best wishes, Simon
Then we must change machine standard settings if we use such needles ?
Sadok Hamza Yes, the low pass filters need to be changed
תודה רבה דוקטור :)
Alguien me puedes traducir porfabor
whats the software called?
Keypoint.Net Its effectively proprietary to the hardware though (Dantec Keypoint G4) Bw Simon
@@DrSimonFreilich thank you, im always curious about the software my doctors use when they check me hah, they made a lot of exams on me, one more painful than the other. The Single Fiber EMG shows abnormal jitter and nowadays get treated for myasthenia gravis