Diagrammatic representation of neuromuscular transmission.

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Diagrammatic representation of neuromuscular transmission. Diagrammatic representation of neuromuscular transmission. (1) Action potential arriving at nerve terminal triggers opening of voltage gated calcium channels (VGCCs) and entry of calcium. (2) Rise in intracellular calcium triggers release of packets of acetylcholine (ACh). (3) Interaction of ACh with ACh receptors (AChR) depolarises post-synaptic membrane. (4) Voltage gated sodium channels (VGSCs) open, triggering muscle action potential. (5) ACh esterase (AChE) breaks ACh into acetyl and choline, which are taken up by the nerve terminal to be reformed into ACh. (6) Opening of voltage gated potassium channels (VGKCs) repolarises nerve terminal. Marguerite Hill J Neurol Neurosurg Psychiatry 2003;74:ii32-ii37 ©2003 by BMJ Publishing Group Ltd