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usually acquired and analyzed to provide adequate statistical signi cance As the need to acquire this amount of data of stems from the observation that MG can be as patchy electrophysiologically as it is clinically Abnormally high jitter values can also be declared if 10% or two of 20 ber pairs have jitter values that exceed a second higher set of normative values that are also age and muscle speci c The bene t of this second set of norms is that it allows this sometimes labor-intensive test to be terminated early if the test is strikingly abnormal Abnormally low jitter values are also potentially pathological As an example, it has been described in disorders associated with myo ber splitting Reduced jitter is uncommonly recognized as disorders with reduced

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jitter values are uncommonly tested with this methodology The second parameter that is typically sought for is neuromuscular blocking Blocking does not typically occur until jitter values are high, typically with MCD values in excess of 100 microseconds Blocking is recognized when a triggering potential, identical in morphology to previous and successive triggering potentials, is unaccompanied by a second, time-locked SFMAP (Figure 2 15b) It is of course possible that the triggering potential itself is blocked, but it is likely that this occurrence would go unrecognized Blocking rarely occurs in seemingly normal, older individuals Another parameter that can be measured by the SFEMG needle is ber density, the electrophysiological analog of reinnervation and the type grouping seen on muscle biopsy Fiber density is not as commonly used as a clinical tool as are assessments of jitter and blocking Under normal circumstances, a random placement of the SFEMG needle will reveal only a single ber action potential from a given motor unit 60% of the time A couplet, as sought after for jitter measurements, will be identi ed in 35% of insertions and a triplet only 5% of the time The technique for ber density determination differs slightly from jitter measurements The SFEMG needle is manipulated so as to obtain maximal amplitude from the rst single ber action potential that is obtained Once that is accomplished, the number of single ber potentials, regardless of size, that are time linked to the index potential is counted This is done for at least an additional 19 potentials The total number of ber potentials is then divided by the number of test sites For example, if 30 potentials are identi ed at 20 sites, the ber density will be 15 Fiber density is considered an index of successful reinnervation and differs from jitter, which in denervating diseases is considered an index of immature reinnervation Contrasting jitter values with ber density values is one way to estimate how complete the reinnervation process is High ber density values with normal jitter are an indication that the reinnervation process has matured Normative values for ber density again vary with patient age and muscle selected and are based on measurements made with SFEMG needles There is another form of SFEMG referred to as stimulated SFEMG In this technique small electrical stimuli are delivered, by a needle electrode, to a nerve ber within the tested muscle Jitter is then recorded from a single muscle ber innervated by the same nerve There are both advantages and disadvantages of this technique As it does not depend on voluntary muscle activation, it is more readily performed on those who cannot (or will not) cooperate As the stimulus rate does not vary as opposed to voluntary activation, a spurious MCD value secondary to varying ring rates will not occur The timeconsuming effort of nding a ber pair is removed from.

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