Neurology in horses encompasses the study of the equine nervous system, including its structure, function, and associated disorders. The equine nervous system is divided into the central nervous system (CNS), consisting of the brain and spinal cord, and the peripheral nervous system (PNS), which includes nerves extending throughout the body. Neurological conditions in horses can manifest as gait abnormalities, behavioral changes, or sensory deficits. Common neurological disorders include equine protozoal myeloencephalitis (EPM), cervical vertebral stenotic myelopathy (CVSM), and equine herpesvirus myeloencephalopathy (EHM). Diagnostic approaches may involve clinical evaluation, imaging techniques, and laboratory tests. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, pathophysiology, diagnosis, and management of neurological disorders in horses.
Blythe LL, Kitchell RL.The cutaneous innervation of the thoracic limb was investigated in 18 barbiturate-anesthetized horses, using electrophysiologic techniques. The cutaneous area (CA) innervated by each cutaneous nerve was delineated in at least 4 horses by stroking the hairs with a small watercolor brush while recording from the nerve. Mapping of adjacent CA revealed areas of considerable overlap. The part of a CA of a given nerve supplied only by that nerve is referred to as its autonomous zone (AZ). In contrast to the standard textbook illustrations cutaneous branches of the axillary, radial, musculocutaneous,...
Tuthill RJ, Clark WH, Levene A.A unique pigmented lesion, judged to be a hamartoma of neural crest origin, occurring in a female patient, is compared with equine melanotic disease, The characteristic perifollicular arrangement of pigment-laden spindle cells is remarkably similar in both. Previously described patch- and plaque-like blue nevi in humans are also closely related. Light and ultrastructural features showed differentiation toward both nevus cells and Schwann cells, and it is proposed that the lesion be termed pilar neurocristic hamartoma.
Mayhew IG, Lichtenfels JR, Greiner EC, MacKay RJ, Enloe CW.A pregnant 10-year-old Paint mare was examined because of an acute neurologic disturbance. Physical examination revealed signs consistent with extensive, asymmetric brain stem disease. The hemogram, serum chemical panel, and results of lumbosacral spinal fluid analysis were within normal limits. A primary diagnosis of equine protozoal myeloencephalitis was considered, and the mare was placed on treatment with trimethoprim-sulfadiazine. After 5 weeks of steady improvement, an acute exacerbation of neurologic signs necessitated euthanasia of the mare. At necropsy, large, malacic tracts were foun...
Raphel CF.Three horses with brain abscesses had different clinical manifestations: 1 had a protracted clinical course whereas 2 had a short clinical course. Clinical signs in 2 horses (1 acute case, 1 chronic case) included unilateral loss of vision, head tilt, circling, abnormal mental status, and ataxia. The 3rd horse had bilateral loss of vision, altered mental status, and apparent deafness. Results of cerebrospinal fluid analysis were inconsistent. The horse with the protracted clinical course had paradoxic central vestibular disease.
Quinlan TJ, Goulden BE, Barnes GR, Anderson LJ, Cahill JI.The nerve supply to the intrinsic laryngeal muscles of the horse was studied by gross dissection and by electromyography which was carried out before, during and after section of various intralaryngeal nerve branches. The anatomical relationships and passage of the laryngeal nerves throughout the larynx were defined. Unlike the dog and man there was no evidence of the passage of motor nerve fibres from one side of the larynx to the other.
Nugent TE, Combie JD, Weld JM, Burns P, Tobin T.The enkephalins are small, pentapeptide neurotransmitter molecules which have reportedly been used in racing horses. In our experiments, D-Ala2-Metenkephalinamide and leucine enkephalin were administered to horses intravenously (IV) and intracisternally (IC). Leucine enkephalin had little effect on locomotor activity by either route at doses of 0.01 mg/Kg or less. Methionine enkephalinamide, an enzyme resistant enkephalin analog, had no significant effect when given IV (0.002 and 0.008 mg/kg). Other experiments involving intracisternal dosing with this long acting form at higher levels (0.005-...
King JM, Roth L, Haschek WM.Focal myocardial necrosis secondary to neural lesions was diagnosed in 2 dogs and 1 horse. In each case, the neural lesions were traumatic in origin. Spinal cord injury was evident in 1 dog; brain damage was evident in the other dog and presumably in the horse. Retrospective analysis of necropsy material showed that many species were affected, without apparent age or sex predisposition. Central nervous system injury resulting from trauma, infection or space-occupying lesions was associated with acute myocardial necrosis in all cases. The myocardial necrosis was rarely fatal; however, it did ca...
Pascoe PJ.A 16 year old Thoroughbred mare was presented to the Ontario Veterinary College because of an acute episode of colic. An exploratory laparotomy was performed and a neurofibroma was identified and successfully removed from the small colon. The clinical and pathological features of this case are discussed.
Sweasey D, Patterson DS, Leadon DP.The lipid content of spinal cord, expressed as a percentage of adult values, was considerably higher for newborn foals than for several other species and traces of esterified cholesterol (type A) were only rarely present in horse fetal cord (from 270 days gestational age onwards). This suggested that, at birth, the spinal cord is neurochemically more 'mature' in the horse than in cattle, sheep and pigs. Data for premature foals revealed no lipid abnormality suggestive of myelin immaturity or degeneration.
Melrose PA, Douglas RH.Scanning electron microscopy showed that cells in the infundibular recess of prepubertal female horses were devoid of cilia and sparsely covered with stubby microvilli and small blebs, whereas superior ventricular areas were covered with cilia. Ciliated ependymal cells in supraoptic-suprachiasmatic areas were associated with extensive blebbing, and folded tissue adjacent to the inferior borders of the mamillary body displayed distinct bands of cilia regularly interrupted by areas of sparsely ciliated cells which appeared to be undergoing ciliogenesis. Arcuate ependymal areas had well developed...
Palmieri G, Asole A, Panu R, Farina V, Sanna L.A vegetative innervation is described for the first time in this district. On the contrary, the finding of Pacini and pacini-like corpuscles, of Golgi Mazzoni's receptors, of muscle spindles and Golgi's tendon-organs testifies the existence of a sensitive innervation in this anatomical territory. According to Karamanlidis free nervous endings are not present. All the above recorded receptors show the typical structure and can be found isolated, grouped to constitute flower-sprays, organized to form opposito-polar corpuscles or associated to originate pecilomorphic fibers. These two last findin...
Henry RW, Diesem CD.Radial and median motor nerve conduction velocities were determined on 10 clinically healthy 1- to 11-year-old ponies. These velocities were obtained by stimulation at the brachial plexus directly through a surgical incision and later in the ambulatory pony via implanted Formvar-coated wire electrodes. Percutaneous stimulation was used at the cubital region in both anesthetized and ambulatory ponies. The values for radial motor nerve fibers ranged from 96.4 to 100 m/s. These were 15.3% faster than previously reported distal values. Median motor nerve fiber values ranged from 86.8 to 90.2 m/s, ...
Sarkar DK, Smith GC, Fink G.We have investigated the effect of manipulating central catecholamines on the timing of puberty (as assessed by vaginal opening) in female rats and the surge of luteinizing hormone (LH) and gonadotropin releasing hormone (GnRH) induced by pregnant mare serum gonadotropin (PMSG) in immature female rats. Manipulation of the catecholamines was carried out with either 6-hydroxydopamine (6-OHDA) administered with or without either desipramine (DMI) or pargyline, or alpha-methyl-p-tyrosine (alpha-MPT). The neonatal administration of 6-OHDA delayed puberty, an effect which was potentiated by pretreat...
Purohit RC, Mysinger PW, Redding RW.A continuous series of electroencephalograms (EEG) was obtained from each of 6 mature horses which had been given xylazine and ketamine hydrochloride IV. Electrocardiograms and respiratory rates were also obtained. The EEG of the unsedated standing adult horse displayed a dominant fast activity in the range of 25-35 Hz, 5-30 microV superimposed over slower 1-4 Hz, 10-50 microV activity with occasional 10-14 Hz, 10-40 microV spindle-type activity. The xylazine-sedated horse displayed hypersynchronous EEG patterns, with the dominant activity being 1-3 Hz, 10-70 microV with overlying mixed freque...
Marshall AE, Byars TD, Whitlock RH, George LW.Brainstem auditory evoked response (BAER) testing was done to evaluate inner ear/VIIIth cranial nerve (CN8) function in the horse. The BAER test consisted of stimulating the auditory system with clicks and recording far-field responses of the brainstem auditory components via cutaneous electrodes and a signal averaging system. The normal response was shown to be a series of waves occurring within the first 10 msec after the stimulus click. Functional loss of the auditory receptor organ (cochlea) or CN8 results in loss of the entire response on the side of the injury. Because of the anatomic re...
Downey BR.Neuroendocrine and endocrine factors involved in the regulation of reproductive cycles in domestic animals are discussed. Although research data from many species are considered, emphasis is placed on their relevance for the cow, sow, ewe and, to a lesser extent, the mare. Literature cited is not designed to be complete, but rather to be representative of the large volume of material which has been written on the subject.Gonadotropin-releasing hormone is synthesized and secreted in response to various exteroceptive stimuli, but both its release and its effects on the anterior pituitary are mod...
Fillion G, Beaudoin D, Rousselle JC, Jacob J.Glial cell membrane fractions were prepared using glial cells preparations isolated from horse brain striatum. [3H]5-HT binding was measured by the filtration technique and the adenylate cyclase activity determined by measuring the cAMP production using a radioimmunoassay. Serotonin binds to glial membrane fractions with an affinity corresponding to a dissociation constant Kd = nM. The corresponding site is serotoninergic specific: [3H]5-HT binding is inhibited by 5-HT agonists (5 OH NM-DMT, 5-MeOHT, 5-MeOH-DMT, NN-DMT) or antagonists (cinanserine, cyproheptadine, methysergide, LSD) and not (o...
Levene A.In man the epidermis is the final destination for most of the melanocytes which are of neural crest origin, and they migrate to a variety of sites. Dermal melanocytic distribution, conspicuous in some lower animals, has a very restricted normal distribution in man, and of the variety of anomalies which exist the blue naevus is the most frequently encountered. It is comparable to the common melanocytoma of dog and hamster. More widespread dermal melanocytoses are rare, and a unique case in which death from melanoma supervened, recently recorded by the author, is an example of a syndrome the onl...
Sławomirski J, Głuszak J.The studies performed on spinal cords of two horses revealed that cells of the nucleus of the own dorsal horn are present in all segments of lumbo-sacral part of the spinal cord. The nucleus is composed of two parts: basal and marginal. Basal part is composed of large and medium size cells situated in 2/3 of the lower part of the grey substance of the dorsal horn. The marginal part of the described nucleus is composed of elongated and spindle shaped cells situated along the dorsal margine of the grey substance of the dorsal horn. Continuity of the nucleus in lumbo-sacral part of the spinal cor...
Hadlow WJ, Ward JK, Krinsky WL.Acute neurologic disease associated with intracranial migration of a first instar larva of a warble fly, Hypoderma bovis (Linnaeus), was observed in a 14-year-old Quarter Horse gelding in western Montana. The disease was characterized by incoordination of gait, circling to the left, head tilt to the right, partial paralysis of the right side of the face, and impaired vision in the right eye. Two and one-half hours after it was first noticed sick, the horse collapsed and was euthanized. Massive hemorrhage unaccompanied by necrosis or significant cellular response was present in the right side o...
McCrindle CM, Ebedes H, Swan GE.Two Arabian horse stallions with behavioural problems were treated with long-acting neuroleptics in order to facilitate corrective training. Perphenazine enanthate, administered intramuscularly at a dose of 0.5 mg kg-1 had an effect for 30 d. Pipothiazine palmitate (1 mg kg-1) induced tranquilization of 30 d duration as well as extra-pyramidal clinical signs, ataxia and aphagia. Neither horse showed prolapse of the penis or haemolysis.
Mayaki AM, Abdul Razak IS, Noraniza MA, Mazlina M, Rasedee A.Neurological disorders (NDs) are often fatal to horses. Thus, symptoms of equine NDs commonly indicate euthanasia. Current diagnostic approaches for equine NDs is based on clinical signs, differential diagnoses, analysis of cerebrospinal fluid (CSF), assessment of histopathological lesions, and imaging. However, advances in biofluid biomarkers in the diagnosis of human neurological diseases can potentially be applied to equine NDs. In this review, we described the established human blood and CSF neurobiomarkers that could potentially be used to diagnose equine NDs.
Valberg SJ.Movement disorders are defined as involuntary movements that are not due to a painful stimulus or associated with changes in consciousness or proprioception. Diagnosis involves ruling out any lameness and neurologic disease and characterizing the gait during walking backward and forward and trotting. Shivers causes abnormal hindlimb hypertonicity during walking backward and, when advanced, a few strides walking forward. Stringhalt causes consistent hyperflexion during walking forward and trotting and variable difficulty when walking backward. Classification and potential causes are discussed a...
Sławomirski J, Flieger S, Jastrzebski M, Boratyński Z.The studies carried out on 2 spinal cords of horses showed that cells of the medial motor nucleus (nucleus motorius medialis) are present in all neuromers of the lumbar and sacral segment of the spinal cord. It lies in the medial part of grey matter of the ventral column, neighbouring laterally and ventrally with cells of the lateral motor nucleus, whereas dorsally with cells of the nucleus of the ventral commissural horn. Along the nucleus numerous constrictions and intervals are found, which are connected with various numbers of nerve cells in particular cross-sections.
Gruys E, Beynen AC, Binkhorst GJ, van Dijk S, Koeman JP, Stolk P.The most important neurodegenerative diseases of the horse are reviewed. In addition to the literature, neurodegenerative diseases occurring in patients (horses, Mongolian Przewalski-horses, and two zebras) referred to the Utrecht Veterinary Faculty are mentioned. Neurodegenerative diseases described are: I. ataxia associated with: A/ static stenosis, B/ dynamic stenosis, C/ lesions at various locations in the central nervous system, D/ equine herpesvirus infections, E/ equine degenerative myelo-encephalopathy, or F/ cerebellar abiotrophy; II. equine motor neuron disease; III. grass sickness o...
Doran G, Hughes K, Rendle D, Edwards S.Pergolide is used to treat pituitary pars intermedia dysfunction (equine Cushing's Disease), a neurodegenerative condition associated with loss of dopaminergic inhibition of the pituitary in horses. After oral administration, only low concentrations of the drug are achieved in plasma, making drug detection and quantification difficult. While direct analysis of plasma using sensitive MS/MS techniques is possible, dirty plasma samples and mobile phase buffers can cause instrumentation to become rapidly incapacitated. A method using LC with fluorescence detection was developed for pergolide analy...
Kelly DF, Pinsent PJ.A 10-month-old thoroughbred colt developed sudden complete blindness; no other neurological abnormality was detected. At necropsy 3.5 months later lesions were confined to both optic pathways in which there was extensive degeneration of axons and myelin and gliosis. The cause of the optic lesion was not determined but the lesion may be a toxic neuropathy.
Colavizza M, Hervagault JF.After extraction and purification, the kinetic behavior of the Ca(2+)/calmodulin-dependent protein kinase II (CaM kinase II) from horse brain was investigated as a function of ATP and a synthetic substrate, syntide-2. Both phospho- and dephospho- forms of the enzyme obey a bi-bi random mechanism. The K(M)s for ATP (K(M,ATP)) and syntide-2 (K(M,syntide-2)) were determined as equal to 80 and 30 microM, respectively. However, the maximum reaction yield is decreased by 50% when the enzyme is (auto)phosphorylated. In addition, this phosphorylated form of the enzyme leads to the formation of a total...
Haughey KG, Jones RT.A high frequency of meningeal lesions was found at autopsy in foals dying perinatally. Such lesions are considered an index of injury to the fetal central nervous system, from trauma and/or hypoxia during birth. Their incidence in the sample examined (26 foals) is similar to that observed in the perinatal mortality of lambs and calves.
Flieger S, Sławomirski J, Boratyński Z, Jastrzebski M.Two medullae oblongatae of horses were cut into 15 microns cross-sections and stained according to the modified method of Nissel. The lateral motor nucleus lies in the lateral and median part of the ventral column of spinal cord grey matter. It adjoins medially nucleus motorius medialis of the spinal ventral column. Cells of this nucleus occur both along the whole lumbar and sacral segment of the spinal cord. In the lateral motor nucleus three cell groups are distinguished-median, basal and lateral. The latter is divided in some segments into subgroups-dorsal and ventral. Along the nucleus qui...
Mayhew IG.Evaluation of horses for eye problems and for suspected impairment of visual acuity often requires a thorough neuroophthalmic examination to be conducted. Along with a full ophthalmic evaluation, the results of such an examination should indicate the likely site of any lesion(s) accounting for blindness, miosis, mydriasis, anisocoria, Horner's syndrome, strabismus, facial paralysis and facial spasm, nystagmus and other signs of vestibular disease, and cerebellar disorders, that may be present. Such a thorough examination with guidance for correct interpretation of findings is given here.
Journée HL, Journée SL.Depending on the localization of the lesion, spinal cord ataxia is the most common type of ataxia in horses. Most prevalent diagnoses include cervical vertebral stenotic myelopathy (CVSM), equine protozoal myeloencephalitis (EPM), trauma and equine degenerative myeloencephalopathy (EDM). Other causes of ataxia and weakness are associated with infectious causes, trauma and neoplasia. A neurologic examination is indispensable to identify the type of ataxia. In addition, clinical neurophysiology offers tools to locate functional abnormalities in the central and peripheral nervous system. Clinical...
Palmieri G, Sanna L, Asole A, Farina V, Bo Minelli L.The origin and course of the collateral sesamoidean (suspensory navicular) ligament of the horse and ass and its attachment to the distal sesamoid bone were studied by means of dissection. Particular attention was given to the topographic relations between this ligament and the deep digital flexor tendon. Numerous sensitive nerve endings are present in this anatomical district. The free and encapsulated nerve endings, displayed by impregnating techniques, are mostly concentrated in the ligament tract connected to the above-named tendon and close to its attachment to the distal sesamoid angle. ...
Pintea V, Ganţă C.The mm. lumbricales and the mm. capsulares of the shoulder and hip joints of the horse are rich in neuromuscular spindles (NMS). The mm. interossei of the pig, but not of the horse, have NMS too. In the m. orbicularis of the eye, m.hyo-epiglotticus and the m. palatinus of the horse NMS are absent. In the vestigial muscles, as m. extensor digitorum brevis and m. of Thiernesse, NMS are absent too. A role of modulator for the proximal muscles of the limbs by the distal muscles is hypothesized, as well as the absence of NMS in striated muscles not involved in locomotion.
Hahn C.The neurological examination is undertaken to determine whether any deficit is due to a lesion in the nervous system and, if so, where within the nervous system any possible lesion or lesions are located. The examination of horses has challenges not encountered when doing the equivalent examination in dogs and cats, principally that spinal reflexes and postural reactions are impossible/difficult to assess in most animals. The anatomy book can be consulted later but at the end of the neurological examination the clinician then should be able to determine broadly which area of the neuromuscular ...
Rojas-Núñez I, Gomez AM, Palmer S, Mohammed HO.Neurofilaments are structural proteins that are concentrated in the body and axons of neurons. Damage to the neurons or axons as a result of trauma or infectious diseases leads to the release of neurofilaments into blood and cerebrospinal fluid (CSF). This case-control study was carried out to compare serum levels of phosphorylated neurofilament heavy chain (pNF-H) between clinically healthy Thoroughbred (TB) horses and TB horses that suffered catastrophic musculoskeletal injuries (cMSI), and to investigate the correlation between putative risk factors and serum concentrations of pNF-H in inju...
Mackie MK.A 13-year-old, Thoroughbred gelding presented with a 3-year history of progressive ataxia of all 4 limbs. Physical and neurological examinations indicated a compressive lesion affecting the cervical spinal cord. Radiographs confirmed a lesion, and a myelogram a narrowing of the spinal canal at cervical vertebrae (6-7). Necropsy confirmed cervical stenotic myelopathy.
Salamanca-Carreño A, Parés-Casanova PM, Crosby-Granados RA, Vélez-Terranova M, Bentez-Molano J.The skull is divided into neurocranium and splanchnocranium, and its variation allows ecomorphological studies to learn about possible evolutionary and adaptive characteristics. The basicranial organization of the neurocranium and splanchnocranium modules was studied in a sample of 31 skulls from adult Araucanian horses by means of 2D geometric morphometric techniques. The neurocranium and splanchnocranium modules on the ventral aspect were analyzed separately using a set of 31 landmarks. The RV coefficient (the multivariate analog of a correlation) was estimated to analyze the independence of...
Calderwood Mays MB, Mayhew IG, Woodard JC.Pigmented nevi have not been widely recognized in domesticated animals. We describe, for the first time, a giant congenital pigmented nevus in a horse. Because of a prominent neuroid component within the lesion, neurofibromatosis was the major differential diagnosis.
Bolat D, Yıldız D, Bahar S, Yürüker S, Kaymaz F, Ilgın C, Bozkurt EÜ, Karahan S, Sabancı SS.We investigated the microscopic structure of transverse sections of the oculomotor, trochlear and abducens nerves of Arabian foals using stereological methods. Bilateral nerve pairs from 2-month-old female Arabian foals were analyzed. The tissues were embedded in plastic blocks, then 1 µm thick sections were cut and stained with osmium tetroxide and methylene blue-azure II. Stereology was performed using light microscopy. Morphometry showed that the right and left pairs of nerves were similar. The transverse sectional areas of the oculomotor, trochlear and abducens nerves were 1.93 ± 0.19 mm...
Sinha AK, Hendrickson DA, Kannegieter NJ.The initial clinical signs displayed by two horses with head trauma are described and related to the pathology and management of the condition, to illustrate the diversity of signs that may result from similar events. It is suggested that careful repeated neurological investigations are more reliable prognostic indicators in cases of equine head trauma than a reliance on the initial assessment.
Kero T, Kuussaari J.The purpose of this communication is to report the first diagnosed case of spinal ataxia in the horse in Finland. The horse was atactic and had a wobbling gait. Especially in turning and backing the rear legs tended to swing outwards. Macroscopical studies revealed malformation of the cervical vertebral articular facets and narrowing of the cervical vertebral canal. The vertebral malformation caused the degeneration of the spinal cord, through the compression of the cord. In this paper the macroscopial and microscopical findings are discussed and compared with the findings of other authors.
Mair TS, Pearson GR.A 3 1/2-year-old bay gelding of the cob type showed nervous signs and coughing associated with breaking-in and exercise. At post-mortem examination, heavy melanin pigmentation of the meninges of the hind brain and the medulla was identified and, on histological examination, melanin-containing cells were found within connective tissue extending into the medulla. The lesion was considered to be a melanotic hamartoma.
Vaughn DM, Smyth GB.The serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA) and the dopamine metabolite, homovanillic acid (HVA) in the cerebrospinal fluid (CSF) of seven clinically normal horses were evaluated with reverse phase high pressure liquid chromatography and electrochemical detection. Comparisons of the neurotransmitter metabolite concentrations were made on CSF collected simultaneously from the atlanto-occipital and lumbosacral regions. There were significantly higher amounts of 5-HIAA and HVA in atlanto-occipital CSF than in lumbosacral CSF. Mean 5-HIAA concentrations in atlanto-occipital and l...
Dau SL, Azevedo MDS, Mazaro RD, de La Corte FD, Fighera R.Neurolytic compounds are widely used by equine practitioners for the management of lameness, mostly related to the foot. The present study aimed to evaluate the neurotoxicity of 2% ammonium chloride (2% AC) applied adjacent to the palmar digital nerves in six miniature horses. The 2% AC and 0.9% saline solution were randomly injected into three and one palmar digital nerve of each horse, respectively. Nerve samples were collected by neurectomy performed under general anesthesia at 5, 12, 19, 35, 47, and 62 days after treatment, with one horse per day of surgery. The inflammatory reaction to p...
Palmieri G, Panu R, Asole A, Branca A.The proprioceptive innervation of the external cremaster muscle of some domestic animals was studied. Muscle spindles and tendon organs with their well-known features were found, but this finding was uncommon and unexpected in the investigated animals. For this reason, we believe that there is no relationship between the presence of these proprioceptors and the cremasteric reflex.
Sloet van Oldruitenborgh-Oosterbaan MM, Binkhorst GJ.The differences in aetiology, symptomatology, pathomorphology, diagnosis and therapy between the nervous form (paralytic form) of Equine Herpes Virus, type 1, and Neuritis Caudae Equinae are reviewed. The conclusion is that in most cases it is possible to differentiate between these two clinical syndromes.
Castro D, Clark-Price S.Pre-existing muscle disorders in horses can often be subtle and may only become evident during or after anesthesia. Advancements in veterinary medicine, along with increased knowledge and research in this field, help minimize anesthesia-related problems. Adequate preanesthesia assessment, early disease diagnosis, and proper management are crucial in minimizing risks to the neuromuscular system during general anesthesia.
