Computer simulation of jitter phenomenon in neuromuscular transmission disorders

Modelling the response to low-frequency repetitive nerve stimulation of myasthenia gravis and Lambert-Eaton myasthenic syndrome

Myasthenia gravis (MG) is an autoimmune postsynaptic disorder of neuromuscular transmission caused, in most patients, by antibodies against postsynaptic acetylcholine receptors. Lambert-Eaton myasthenic syndrome (LEMS) is a presynaptic autoimmune disease in which there is a reduction in Ca²⁺ entry with each impulse due to the action of antibodies against Ca²⁺ channels. These diseases have a distinct pattern of response to low-frequency repetitive nerve stimulation which allows its recognition in a particular subject. Nevertheless, the physiologic basis of this response is not entirely known. A model of the time-course of release probability of neuromuscular junctions that incorporates facilitation and a depression-recovery mechanism has been developed with the aim to investigate these response patterns. When the basal value of release probability was in the physiologic range, as in MG, release probability showed an increment after its initial decrease only if the recovery from depression was accelerated by presynaptic residual Ca²⁺. Otherwise, when the basal release probability was low, as in LEMS, a progressive reduction in the release probability without any late increase was only obtained if the efficacy of Facilitation and Ca²⁺-dependent recovery from depression were reduced.

Safety margin at single neuromuscular junctions

Jitter measurement with axonal microstimulation was used to study synaptic function at 115 neuromuscular junctions (NMJs) of normal subjects at various stimulation rates. Jitter was lowest at 0.5 Hz; it increased slightly at 1, 2, and 5 Hz and remained at that level at 10 Hz (a light work load) and 20 Hz (a heavy work load); and it increased further at 50 Hz (an extreme load). This pattern was seen for the majority of the NMJs, suggesting a high safety factor of neuromuscular transmission maintained rather uniformly over a wide range of discharge rates. A proportion of the normal NMJs had relatively large jitter; these tended to show prominent facilitation as the rate was raised from 5 or 10 to 20 Hz. Similar but more dramatic facilitation improving the safety factor was seen at most NMJs in myasthenia, which was studied for comparison. Such facilitation was not found at normal NMJs with low jitter.