Repetitive nerve stimulation cutoff values for the diagnosis of myasthenia gravis
ABSTRACT Introduction Repetitive nerve stimulation (RNS) showing ≥ 10% decrement is considered the cutoff for myasthenia gravis (MG), but this has never been validated. The objective of this study was to find an optimal validated cutoff value for decrement on RNS. Methods: We performed retrospective...
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| Veröffentlicht in: | Muscle & nerve 2017-02, Vol.55 (2), p.166-170 |
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| creator | Abraham, Alon Alabdali, Majed Alsulaiman, Abdulla Breiner, Ari Barnett, Carolina Katzberg, Hans D. Lovblom, Leif E. Bril, Vera |
| description | ABSTRACT
Introduction
Repetitive nerve stimulation (RNS) showing ≥ 10% decrement is considered the cutoff for myasthenia gravis (MG), but this has never been validated. The objective of this study was to find an optimal validated cutoff value for decrement on RNS. Methods: We performed retrospective chart review of patients who had electrophysiological assessment for possible MG from 2013 to 2015. Results: A total of 122 patients with MG and 182 controls were identified. RNS sensitivities for generalized and ocular MG using the traditional ≥10% cutoff value were 46% and 15%, respectively, for frontalis recordings, and 35% and 19%, respectively, for nasalis recordings. Using a decrement cutoff value of 7% for frontalis and 8% for nasalis increased the sensitivities by 6–11%, with specificities of 95–96%. Conclusions: For RNS in facial muscles, we suggest a cutoff value of 7–8%, which increases test sensitivity by 6–11%, while preserving high specificity for the diagnosis of MG. Muscle Nerve, 2016 Muscle Nerve 55: 166–170, 2017 |
| doi_str_mv | 10.1002/mus.25214 |
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Introduction
Repetitive nerve stimulation (RNS) showing ≥ 10% decrement is considered the cutoff for myasthenia gravis (MG), but this has never been validated. The objective of this study was to find an optimal validated cutoff value for decrement on RNS. Methods: We performed retrospective chart review of patients who had electrophysiological assessment for possible MG from 2013 to 2015. Results: A total of 122 patients with MG and 182 controls were identified. RNS sensitivities for generalized and ocular MG using the traditional ≥10% cutoff value were 46% and 15%, respectively, for frontalis recordings, and 35% and 19%, respectively, for nasalis recordings. Using a decrement cutoff value of 7% for frontalis and 8% for nasalis increased the sensitivities by 6–11%, with specificities of 95–96%. Conclusions: For RNS in facial muscles, we suggest a cutoff value of 7–8%, which increases test sensitivity by 6–11%, while preserving high specificity for the diagnosis of MG. Muscle Nerve, 2016 Muscle Nerve 55: 166–170, 2017</description><identifier>ISSN: 0148-639X</identifier><identifier>EISSN: 1097-4598</identifier><identifier>DOI: 10.1002/mus.25214</identifier><identifier>PMID: 27287989</identifier><identifier>CODEN: MUNEDE</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adrenal glands ; Adult ; Aged ; Biophysics ; Electric Stimulation - methods ; Electromyography ; Evoked Potentials, Motor - physiology ; Female ; Health risk assessment ; Humans ; Male ; Middle Aged ; Muscle, Skeletal - physiopathology ; myasthenia gravis ; Myasthenia Gravis - diagnosis ; Myasthenia Gravis - physiopathology ; repetitive nerve stimulation ; Retrospective Studies ; sensitivity ; single fiber EMG ; specificity</subject><ispartof>Muscle & nerve, 2017-02, Vol.55 (2), p.166-170</ispartof><rights>2016 Wiley Periodicals, Inc.</rights><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3864-4ad2d4da4a31f4fd01f44b6bf31fa942eafc6d33dd20f780744abd55531116873</citedby><cites>FETCH-LOGICAL-c3864-4ad2d4da4a31f4fd01f44b6bf31fa942eafc6d33dd20f780744abd55531116873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fmus.25214$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fmus.25214$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27287989$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abraham, Alon</creatorcontrib><creatorcontrib>Alabdali, Majed</creatorcontrib><creatorcontrib>Alsulaiman, Abdulla</creatorcontrib><creatorcontrib>Breiner, Ari</creatorcontrib><creatorcontrib>Barnett, Carolina</creatorcontrib><creatorcontrib>Katzberg, Hans D.</creatorcontrib><creatorcontrib>Lovblom, Leif E.</creatorcontrib><creatorcontrib>Bril, Vera</creatorcontrib><title>Repetitive nerve stimulation cutoff values for the diagnosis of myasthenia gravis</title><title>Muscle & nerve</title><addtitle>Muscle Nerve</addtitle><description>ABSTRACT
Introduction
Repetitive nerve stimulation (RNS) showing ≥ 10% decrement is considered the cutoff for myasthenia gravis (MG), but this has never been validated. The objective of this study was to find an optimal validated cutoff value for decrement on RNS. Methods: We performed retrospective chart review of patients who had electrophysiological assessment for possible MG from 2013 to 2015. Results: A total of 122 patients with MG and 182 controls were identified. RNS sensitivities for generalized and ocular MG using the traditional ≥10% cutoff value were 46% and 15%, respectively, for frontalis recordings, and 35% and 19%, respectively, for nasalis recordings. Using a decrement cutoff value of 7% for frontalis and 8% for nasalis increased the sensitivities by 6–11%, with specificities of 95–96%. Conclusions: For RNS in facial muscles, we suggest a cutoff value of 7–8%, which increases test sensitivity by 6–11%, while preserving high specificity for the diagnosis of MG. Muscle Nerve, 2016 Muscle Nerve 55: 166–170, 2017</description><subject>Adrenal glands</subject><subject>Adult</subject><subject>Aged</subject><subject>Biophysics</subject><subject>Electric Stimulation - methods</subject><subject>Electromyography</subject><subject>Evoked Potentials, Motor - physiology</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Muscle, Skeletal - physiopathology</subject><subject>myasthenia gravis</subject><subject>Myasthenia Gravis - diagnosis</subject><subject>Myasthenia Gravis - physiopathology</subject><subject>repetitive nerve stimulation</subject><subject>Retrospective Studies</subject><subject>sensitivity</subject><subject>single fiber EMG</subject><subject>specificity</subject><issn>0148-639X</issn><issn>1097-4598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1LAzEQhoMoWqsH_4AEvOhh23xtkj1K8Qsq4kfB25JuEo3sbmqyW-m_N1r1IAheZpjh4WGGF4ADjEYYITJu-jgiOcFsAwwwKkTG8kJuggHCTGacFo87YDfGF4QQllxsgx0iiBSFLAbg9s4sTOc6tzSwNSHV2Lmmr1XnfAurvvPWwqWqexOh9QF2zwZqp55aH12E3sJmpWJatk7Bp6CWLu6BLavqaPa_-hDMzs8eJpfZ9ObianI6zSoqOcuY0kQzrZii2DKrUapszuc2japgxChbcU2p1gRZIZFgTM11nucUY8yloENwvPYugn9N53Vl42Jl6lq1xvexTK9KiiSR9B8o4byQImcJPfqFvvg-tOmRDyFiglCOE3WypqrgYwzGlovgGhVWJUblRyRliqT8jCSxh1_Gft4Y_UN-Z5CA8Rp4c7VZ_W0qr2f3a-U7wS-Vdg</recordid><startdate>201702</startdate><enddate>201702</enddate><creator>Abraham, Alon</creator><creator>Alabdali, Majed</creator><creator>Alsulaiman, Abdulla</creator><creator>Breiner, Ari</creator><creator>Barnett, Carolina</creator><creator>Katzberg, Hans D.</creator><creator>Lovblom, Leif E.</creator><creator>Bril, Vera</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TM</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201702</creationdate><title>Repetitive nerve stimulation cutoff values for the diagnosis of myasthenia gravis</title><author>Abraham, Alon ; Alabdali, Majed ; Alsulaiman, Abdulla ; Breiner, Ari ; Barnett, Carolina ; Katzberg, Hans D. ; Lovblom, Leif E. ; Bril, Vera</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3864-4ad2d4da4a31f4fd01f44b6bf31fa942eafc6d33dd20f780744abd55531116873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adrenal glands</topic><topic>Adult</topic><topic>Aged</topic><topic>Biophysics</topic><topic>Electric Stimulation - methods</topic><topic>Electromyography</topic><topic>Evoked Potentials, Motor - physiology</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Muscle, Skeletal - physiopathology</topic><topic>myasthenia gravis</topic><topic>Myasthenia Gravis - diagnosis</topic><topic>Myasthenia Gravis - physiopathology</topic><topic>repetitive nerve stimulation</topic><topic>Retrospective Studies</topic><topic>sensitivity</topic><topic>single fiber EMG</topic><topic>specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abraham, Alon</creatorcontrib><creatorcontrib>Alabdali, Majed</creatorcontrib><creatorcontrib>Alsulaiman, Abdulla</creatorcontrib><creatorcontrib>Breiner, Ari</creatorcontrib><creatorcontrib>Barnett, Carolina</creatorcontrib><creatorcontrib>Katzberg, Hans D.</creatorcontrib><creatorcontrib>Lovblom, Leif E.</creatorcontrib><creatorcontrib>Bril, Vera</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Muscle & nerve</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abraham, Alon</au><au>Alabdali, Majed</au><au>Alsulaiman, Abdulla</au><au>Breiner, Ari</au><au>Barnett, Carolina</au><au>Katzberg, Hans D.</au><au>Lovblom, Leif E.</au><au>Bril, Vera</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repetitive nerve stimulation cutoff values for the diagnosis of myasthenia gravis</atitle><jtitle>Muscle & nerve</jtitle><addtitle>Muscle Nerve</addtitle><date>2017-02</date><risdate>2017</risdate><volume>55</volume><issue>2</issue><spage>166</spage><epage>170</epage><pages>166-170</pages><issn>0148-639X</issn><eissn>1097-4598</eissn><coden>MUNEDE</coden><abstract>ABSTRACT
Introduction
Repetitive nerve stimulation (RNS) showing ≥ 10% decrement is considered the cutoff for myasthenia gravis (MG), but this has never been validated. The objective of this study was to find an optimal validated cutoff value for decrement on RNS. Methods: We performed retrospective chart review of patients who had electrophysiological assessment for possible MG from 2013 to 2015. Results: A total of 122 patients with MG and 182 controls were identified. RNS sensitivities for generalized and ocular MG using the traditional ≥10% cutoff value were 46% and 15%, respectively, for frontalis recordings, and 35% and 19%, respectively, for nasalis recordings. Using a decrement cutoff value of 7% for frontalis and 8% for nasalis increased the sensitivities by 6–11%, with specificities of 95–96%. Conclusions: For RNS in facial muscles, we suggest a cutoff value of 7–8%, which increases test sensitivity by 6–11%, while preserving high specificity for the diagnosis of MG. Muscle Nerve, 2016 Muscle Nerve 55: 166–170, 2017</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27287989</pmid><doi>10.1002/mus.25214</doi><tpages>5</tpages></addata></record> |
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| subjects | Adrenal glands Adult Aged Biophysics Electric Stimulation - methods Electromyography Evoked Potentials, Motor - physiology Female Health risk assessment Humans Male Middle Aged Muscle, Skeletal - physiopathology myasthenia gravis Myasthenia Gravis - diagnosis Myasthenia Gravis - physiopathology repetitive nerve stimulation Retrospective Studies sensitivity single fiber EMG specificity |
| title | Repetitive nerve stimulation cutoff values for the diagnosis of myasthenia gravis |
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