EMG/NCS: Guidelines for Single Fiber EMG

A case of the jitters

Donald B Sanders , Kimiyoshi Arimura , LiYing Cui , Mustafa Ertaş , Maria Elena Farrugia ,
James Gilchrist , João Aris Kouyoumdjian , Luca Padua , Matthew Pitt and Erik Stålberg


The measurement of CNE signals for jitter analysis is sometimes hard to grasp.  Single fiber EMG (SFEMG) are found to be remarkably sensitive in detecting disturbed neuromuscular transmission (NMT), and the method was introduced into clinical use to identify myasthenic disorders.  Development of the SFEMG technique required novel technical features, some of which, such as signal trigger and signal delay, have become standard in current EMG equipment.

Most current EMG machines have software that supports the application of SFEMG. Although they differ in some technical features, all record and analyze jitter. The use of concentric needle electrodes (CNE) as a replacement for SFEMG electrodes (SFE) to measure jitter, which is a consequence of restrictions on the use of reusable electrodes in many countries, makes it necessary to consider new standards for signals measured with these electrodes. The performance of jitter measurements with SFEs or CNEs is technically demanding, requiring considerable time and experience to develop the skills necessary to obtain quality recordings within a reasonable period of time. Signal analysis techniques should be developed to automatically evaluate the quality of recorded signals to detect artifacts and composite signals, and thus reduce the operator time necessary to assure the quality of CNE signals for jitter analysis. “Disposable” reasonably-priced SFEMG electrodes should be developed to permit recordings consistent with the original jitter analysis technique.

This article represents a consensus of international experts in the field of EMG as to the current status of single fiber EMG (SFEMG) and jitter measurement using concentric needle electrodes (CNE).

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July 13, 2020
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