Panel II on the Therapies of the Depressive Illnesses Tendon Reflexes as a Guide to the Safe use of Succinylcholine in Medicine

Familiarity with certain physiologic and biochemical reactions and factors of succinylcholine (SCh) in man is helpful in safely administering SCh in convulsive therapy and anesthesiology. These reactions and factors are: 1) the natural variations in the titer of butyrylcholinesterase (BChE) in the plasma, 2) the interactions between SCh with BChE, 3) the action of SCh in the congenital absence of BChE, 4) understanding of the mechanism of transmission of the nerve impulse, 5) the action of succinylcholine at the motor end plate. Discussion of the above reactions and factors are presented. Two physiologic tests are described. These are the 3 mg SCh test dose and the tendon reflex test. The proper application of these two tests make possible the safest use of succinylcholine in convulsive therapy, as well as in other fields of medicine.

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Address of the President Professor P. M. S. Blackett, O.M., C.H., at the Anniversary Meeting, 30 November 1967

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1968.0007 ◽

1968 ◽

Vol 169 (1016) ◽

Cited By ~ 1

Keyword(s):

Spinal Cord ◽

Nervous System ◽

Nerve Impulse ◽

Nervous Impulse ◽

End Plate ◽

Motor End Plate ◽

Set Up ◽

Brain And Spinal Cord ◽

The Brain ◽

Quantitative Tool

The Copley Medal is awarded to Professor B. Katz, F. R. S. Professor Katz’s researches have mainly been concerned with the mechanism of junctional transmission between nerve and muscle, but earlier he played an important part in helping Hodgkin and Huxley to establish the ionic theory of the nervous impulse. He set out to examine the nature of the end-plate potential with intracellular micro-electrodes, and showed that the arrival of a nerve impulse at the motor end-plate had the effect of short-circuiting the resistive membrane of the muscle fibre so as to set up a propagated action potential in the fibre. This led him to the discovery of the spontaneous ‘miniature’ end-plate potentials, which are due to a quanta! random release from the nerve endings of the chemical transmitter acetylcholine. He went on to develop as a precise and quantitative tool the technique of applying minute quantities of drugs at selected spots by releasing them electro-phoretically from micropipettes, in order to study the pharmacology of the motor end-plate. The concepts and methods introduced by Professor Katz in each phase of this work have been widely applied to study junctional transmission elsewhere, for example in the brain and spinal cord, so that he has had a considerable influence on the development of our ideas about the detailed working of the nervous system.

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Address of the President Professor P. M. S. Blackett, O.M., C.H., at the Anniversary Meeting, 30 November 1967

Proceedings of the Royal Society of London Series A - Mathematical and Physical Sciences ◽

10.1098/rspa.1968.0214 ◽

1968 ◽

Vol 303 (1472) ◽

Keyword(s):

Spinal Cord ◽

Nerve Impulse ◽

Considerable Influence ◽

Nervous Impulse ◽

End Plate ◽

Motor End Plate ◽

Set Up ◽

Brain And Spinal Cord ◽

The Brain ◽

Quantitative Tool

The Copley Medal is awarded to Professor B. Katz, F. R. S. Professor Katz’s researches have mainly been concerned with the mechanism of junctional transmission between nerve and muscle, but earlier he played an important part in helping Hodgkin and Huxley to establish the ionic theory of the nervous impulse. He set out to examine the nature of the end-plate potential with intracellular micro-electrodes, and showed that the arrival of a nerve impulse at the motor end-plate had the effect of short-circuiting the resistive membrane of the muscle fibre so as to set up a propagated action potential in the fibre. This led him to the discovery of the spontaneous ‘miniature’ end-plate potentials, which are due to a quantal random release from the nerve endings of the chemical transmitter acetylcholine. He went on to develop as a precise and quantitative tool the technique of applying minute quantities of drugs at selected spots by releasing them electrophoretically from micropipettes, in order to study the pharmacology of the motor end-plate. The concepts and methods introduced by Professor Katz in each phase of this work have been widely applied to study junctional transmission elsewhere, for example in the brain and spinal cord, so that he has had a considerable influence on the development of our ideas about the detailed working of the nervous system.

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The electric activity of the motor end-plate

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1952.0055 ◽

1952 ◽

Vol 140 (899) ◽

pp. 183-186 ◽

Cited By ~ 24

Keyword(s):

Muscle Fibre ◽

Motor Nerve ◽

Nerve Impulse ◽

Electric Activity ◽

Muscle Fibres ◽

Specific Chemical ◽

End Plate ◽

Motor End Plate ◽

Direct Spread ◽

Nerve Muscle

At the nerve-muscle junction, a specific process occurs which is not found during the propagation of impulses along nerve or muscle fibres; the nerve impulse causes acetylcholine (Ach) to be released from the motor nerve endings, and this substance depolarizes the end-plate surface of the muscle fibre by a specific chemical reaction. The transient local depolarization of the muscle fibre which is so produced has been called the end-plate potential (e.p.p.). The e.p.p., then, unlike the nerve or muscle impulse, is not itself produced by electric stimulation (direct spread of electric current from nerve to muscle has, in fact, never been demonstrated and appears to be indetectably small). On the other hand, the e.p.p. electrically stimulates the surrounding region of the muscle fibre, and so gives rise to the propagation of a new impulse.

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TENDON REFLEX AND STRATEGIES FOR QUANTIFICATION, WITH NOVEL METHODS INCORPORATING WIRELESS ACCELEROMETER REFLEX QUANTIFICATION DEVICES, A PERSPECTIVE REVIEW

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519410003733 ◽

2011 ◽

Vol 11 (03) ◽

pp. 471-513 ◽

Cited By ~ 25

Author(s):

ROBERT LEMOYNE ◽

TIMOTHY MASTROIANNI ◽

CRISTIAN COROIAN ◽

WARREN GRUNDFEST

Keyword(s):

Longitudinal Study ◽

Patellar Tendon ◽

Neurological Examination ◽

Deep Tendon Reflex ◽

Reflex Response ◽

Fundamental Aspect ◽

Tendon Reflex ◽

Reflex System ◽

Wireless Accelerometer ◽

Tendon Reflexes

The deep tendon reflex is a fundamental aspect of a neurological examination. The two major parameters of the tendon reflex are response and latency, which are presently evaluated qualitatively during a neurological examination. The reflex loop is capable of providing insight into the status and therapy response of both upper and lower motor neuron syndromes. Attempts have been made to ascertain reflex response and latency; however, these systems are relatively complex, resource intensive, with issues of consistent and reliable accuracy. The solution presented is a wireless quantified reflex device using tandem three-dimensional (3D) wireless accelerometers to obtain response based on acceleration waveform amplitude and latency derived from temporal acceleration waveform disparity. Three specific aims have been established for the proposed wireless quantified reflex device: (1) Demonstrate the wireless quantified reflex device is reliably capable of ascertaining quantified reflex response and latency using a quantified input. (2) Evaluate the precision of the device using an artificial reflex system. (3) Conduct a longitudinal study respective of subjects with healthy patellar tendon reflexes, using the wireless quantified reflex evaluation device to obtain quantified reflex response and latency. Aim 1 has led to a steady evolution of the wireless quantified reflex device from a singular 2D wireless accelerometer capable of measuring reflex response to a tandem 3D wireless accelerometer capable of reliably measuring reflex response and latency. The hypothesis for aim 1 is that a reflex quantification device can be established for reliably measuring reflex response and latency for the patellar tendon reflex, comprised of an integrated system of wireless 3D MEMS accelerometers. Aim 2 further emphasized the reliability of the wireless quantified reflex device by evaluating an artificial reflex system. The hypothesis for aim 2 is that the wireless quantified reflex device can obtain reliable reflex parameters (response and latency) from an artificial reflex device. Aim 3 synthesizes the findings relevant to aim 1 and 2, while applying the wireless accelerometer reflex quantification device to a longitudinal study of healthy patellar tendon reflexes. The hypothesis for aim 3 is that during a longitudinal evaluation of the deep tendon reflex the parameters for reflex response and latency can be measured with a considerable degree of accuracy, reliability, and reproducibility. Enclosed is a detailed description of a wireless quantified reflex device with research findings and potential utility of the system, inclusive of a comprehensive description of tendon reflexes, prior reflex quantification systems, and correlated applications.

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Experimental neonatal autoimmune myasthenia gravis: an immunohistochemical, ultrastructural and electrophysiological study of the motor end-plate

Journal of the Neurological Sciences ◽

10.1016/0022-510x(95)00127-n ◽

1995 ◽

Vol 132 (2) ◽

pp. 97-104

Author(s):

Naoko Tetsuo ◽

Mitsuhiro Tsujihata ◽

Akira Satoh ◽

Toshiro Yoshimura ◽

Tatsufumi Nakamura ◽

...

Keyword(s):

Myasthenia Gravis ◽

Electrophysiological Study ◽

End Plate ◽

Motor End Plate ◽

Autoimmune Myasthenia

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A study of the effect of X-rays on the electrical properties of mammalian nerve and muscle

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1963.0027 ◽

1963 ◽

Vol 157 (969) ◽

pp. 536-561 ◽

Cited By ~ 4

Keyword(s):

Dose Rate ◽

Action Potentials ◽

Time Course ◽

Low Dose ◽

High Dose ◽

X Rays ◽

Low Dose Rate ◽

End Plate ◽

Small Doses ◽

Motor End Plate

Resting potentials, action potentials, and miniature end-plate potentials have been recorded from isolated phrenic-diaphragm preparations of the rat during and after irradiation with X-rays. Relatively small doses of a few thousand roentgens have no obvious effect on the preparation for many hours but larger doses, of the order of 70 to 150 kr irreversibly block neuromuscular transmission. The block is not accompanied by any change in the size of action potentials, resting potentials, membrane constants or miniature potentials recorded in the muscle with intracellular electrodes, or in the size of action potentials recorded in the nerve. Records made at the motor end-plate show that the cause of the block is a ‘pre-synaptic ’ failure of impulse propagation in the intramuscular part of the nerve. The time course of the failure depends largely on the rate at which X-rays are delivered to the preparation: at a high dose-rate (70kr/min) the block develops rapidly and is accompanied by an increase in the frequency of miniature potentials; at a low dose-rate (7 kr/min) larger doses are required, the latency is longer and the miniature potentials continue at a normal frequency. The sequence in which different parts of the muscle become blocked, the abrupt nature of the failure at an individual motor end-plate, and the increase in frequency of the miniature potentials together suggest that the action of X-rays is to block conduction in the nerve near its terminals, possibly by depolarizing points where the axons branch and the safety factor for the propagation of impulses is low. The results reported in this paper do not support the hypotheses that small doses of X-rays at a high or a low dose-rate lead to an initial 'enhancement' of function or that they produce immediate and reversible changes in the permeability of excitable membranes to ions.

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