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To the Editor:
Terwindt et al.1 stress the importance of methodological factors in single fiber EMG (SFEMG). When we performed the first SFEMG study in migraine,2 we were aware that adequate training was necessary to avoid technical flaws. The statement by Terwindt et al.1 that jitter is pronounced before blocking occurs cannot be generalized. It does not apply to botulism for instance, and may also not apply to migraine. Complete blinding seems illusory in patients with rare conditions who undergo multiple investigations. We chose to limit blinding to the migraine subtype,2 which likely avoided significant bias, as SFEMG abnormalities were found in only 17 out of 62 patients.
It surprised us that Terwindt et al.1 found that “the contrast” between our SFEMG report and their normal findings in familial hemiplegic migraine (FHM) patients with a proven mutation in the CACNA1A gene “remarkable.” First, there is no …
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