Role of Electrophysiology in Snake Envenomation Two Illustrative Cases

Two patients of snakebite with neurotoxic symptoms were evaluated for understanding the neurophysiological manifestations of snake venom by electrophysiological testing. The testing revealed evidence of neuromuscular junction dysfunction in both cases with decremental response. This response was more evident on higher stimulation rates indicating a post-synaptic defect distinctive from myasthenia gravis. EMG study in the first case provided a distinction between myokymia and fasciculations. Snake envenomation can often present as a myasthenic syndrome with ambiguous history and in such cases electrophysiology can give a clue to the diagnosis.