Neuromuscular Laboratory The Neuromuscular Laboratory provides sub-specialty laboratory services essential for the diagnosis of muscle and nerve diseases. These include a muscle and nerve biopsy histopathology diagnostic service, and immunological tests for autoantibodies to neural antigens associated with neurological disease.

Muscle Biopsy A comprehensive battery of histology and histochemical stains on frozen sections, plus standard histology stains on paraffin sections, are routinely conducted: Routine histology stains: H&E, Gomori's trichrome, Verhoff van Gieson, Congo red, Sudan black, PAS Routine histochemical stains: NADH-TR, succinic dehydrogenase, cytochrome oxidase, acid phosphatase, alkaline phosphatase, non-specific esterase, myosin ATPase at pH 4.3, 4.6 and 9.4. Histochemical stains when applicable: Myophosphorylase, phosphofructokinase, myoadenylate deaminase Electron microscopy is not routinely conducted, but is available if specifically required.               Combined cytochrome oxidase-succinic dehydrogenase stain in a case of MERRF showing COX negative fibres stained blue for SDH instead of brown for COX    Gomori's trichrome stain in a case     of hereditary hyaline inclusion body       myopathy. Note well demarcated areas of      homogenously reduced staining    with hyaline appearance in sarcoplasm    Diagnosis of specific forms of muscular dystrophy and genetic myopathies by immunohistochemistry &/or Western blot for relevant proteins (in brackets below) Duchenne & Becker muscular dystrophy (dystrophin N-terminus, rod domain, C-terminus) Limb Girdle Muscular Dystrophies (LGMD) LGMD 2A (calpain 3) LGMD 2B and Miyoshi myopathy (dysferlin)  LGMD 2C, D,E and F ( α, β, γ & δ sarcoglycan respectively) LGMD 2G (telethonin) LGMD 2I (see below - diseases with disordered α-dystrogiycan glycosylation)  LGMD1C and syndromes associated with caveolinopathy (caveolin 3)  X-linked Emery Dreifuss Disease (emerin) Merosin-negative Congenital Muscular Dystrophy (merosin)  Diseases with disordered α-dystroglycan glycosylation - LGMD2I, MDCIC, Fukuyama CMD, MEB, WWS (α- and β- dystroglycan) Myofibrillar myopathy, cytoplasmic body myopathy, spheroid body myopathy, desmin related myopathy (desmin, α β-crystallin) Diagnosis of inflammatory myopathies - MHC class I immunohistochemistry is conducted in addition to routine histology & histochemical stains. Nerve Biopsy For histological diagnosis of peripheral nerve diseases, semi-thin section histology and frozen & paraffin section histology are routinely conducted. Immunohistochemistry for P-amyloid, kappa & lambda light chains and transthyretin (prealbumin) is available for analysis of amyloid detected on nerve or muscle biopsy. Electron microscopy is not routinely conducted but is available when specifically required. Tests for Autoantibodies to Neural Antigens The following tests for autoantibodies to neural antigens are offered: ELISA assay for Anti-Ganglioslide Antibodies associated with immune mediated peripheral neuropathies. IgG anti-GMI antibody (Axonal Guillain Barre syndrome) IgM anti-GMI antibody (Multifocal motor neuropathy) IgG anti-GQ1b anti-body (Miller Fisher syndrome & variants) Immunohistochemical Screen for Paraneoplastic Anti-Neuronal Antibodies Antibodies detectable include anti-Hu antibody (paraneoplastic encephalomyelitis-sensory neuronopathy), anti-Yo antibody (paraneoplastic cerebellar degeneration) Operating Hours Monday to Friday:                                8.00am to 5.30pm Thursday:                                            8.00am to 5.00pm Saturday, Sunday & Public Holidays:    Closed Location Neuromuscular Laboratory (Level 2) National Neuroscience Institute 11 Jalan Tan Tock Seng Singapore 308433     Enquiries & Referrals Telephone:  (65) 6357-7126 / (65) 6357-7132 Facsimile:   (65) 6357-7108