Repetitive magnetic nerve stimulation: technical considerations and clinical use in the assessment of neuromuscular transmission.

We assessed to what extent repetitive magnetic stimulation can replace the electrical method. Fifteen healthy subjects and 3 patients with myasthenia gravis were investigated using stimulation of the median, ulnar, axillary and accessory nerves. Single, as well as 3/sec repetitive magnetic and electrical stimuli were applied. When comparing the results of magnetic vs. electrical stimulation, amplitudes, areas and shapes of compound muscle action potentials were not significantly different. Although single magnetic stimuli were much less uncomfortable than the electrical stimuli, differences in comfort were much smaller in the repetitive protocol, because muscular contractions under the magnetic stimulation coil caused unpleasant movements of, for example, the neck. Additional problems arose from technical limitations of the prototype magnetic stimulator used: stimulation intensity was significantly limited, resulting in an inability to elicit supramaximal responses in 11 of the 154 investigations. Overheating of the stimulator coil forced us to give the coil extra time to cool down. These problems might be solved in the future by more focused stimulus geometry and introduction of cooling devices. It is concluded that magnetic stimulation can elicit responses which are equivalent to the electrical method in repetitive nerve stimulation. At present due to some shortcomings it cannot replace electrical stimulation in routine repetitive nerve stimulation.