Kozák Márk, Szatmári Katalin, Németh Erzsébet, Fülesdi Béla, Nagy Attila, Tóth Attila, Boczán Judit
Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Muscle Nerve. 2025 Aug;72(2):306-312. doi: 10.1002/mus.28445. Epub 2025 May 28.
INTRODUCTION/AIMS: The repetitive nerve stimulation (RNS) test is fundamental to test the functional integrity of the neuromuscular junction. RNS data are scarce for newborns and young children, limiting early diagnostic efforts to identify children with neuromuscular diseases. Here, we performed RNS in young children.
RNS of the axillary nerve was performed in 34 otherwise healthy young children (0 to 48 months of age) undergoing procedural sedation or analgesia. Compound muscle action potentials (CMAP) were recorded over the deltoid muscle. CMAP amplitude and area decrement between the 1st and 4th potential were determined at 3 Hz stimulation. Post-tetanic facilitation, twitch-to-tetanus ratio, and heart rates were recorded.
The largest CMAP amplitude decrement value was 7% at rest, having a median of 1%, and an interquartile range of 1%-3%. There was no correlation between the CMAP amplitude decrement and age. In contrast, a moderate positive correlation was found between the CMAP area decrement and age, occasionally exceeding 10% in infants younger than 6 months. Both post-tetanic facilitation and twitch-to-tetanus ratio exhibited a moderate positive correlation with age.
While the CMAP amplitude decrement in young children was within the adult normal range, the area decrement may be higher. Studies of RNS on other nerves in unsedated children are needed to investigate the findings from this study further.
引言/目的：重复神经电刺激（RNS）测试是检测神经肌肉接头功能完整性的基础。关于新生儿和幼儿的RNS数据稀缺，这限制了早期诊断工作，难以识别患有神经肌肉疾病的儿童。在此，我们对幼儿进行了RNS测试。
对34名接受程序性镇静或镇痛的健康幼儿（0至48个月）进行腋神经的RNS测试。在三角肌上记录复合肌肉动作电位（CMAP）。在3Hz刺激下测定第1个和第4个电位之间的CMAP波幅和面积衰减。记录强直后易化、单刺激与强直刺激比值以及心率。
静息时最大的CMAP波幅衰减值为7%，中位数为1%，四分位间距为1% - 3%。CMAP波幅衰减与年龄之间无相关性。相比之下，CMAP面积衰减与年龄之间存在中度正相关，在6个月以下婴儿中偶尔超过10%。强直后易化和单刺激与强直刺激比值均与年龄呈中度正相关。
虽然幼儿的CMAP波幅衰减在成人正常范围内，但面积衰减可能更高。需要对未镇静儿童的其他神经进行RNS研究，以进一步探究本研究结果。
