Misdiagnosis of Myasthenia Gravis and Subsequent Clinical Implication : A Case Report and Review of Literature

Al‐Asmi, Abdullah; Nandhagopal, Ramachandiran; Jacob, P. C.; Gujjar, Arunodaya R.

doi:10.12816/0003095

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…MG can be difficult to diagnose as symptoms can mimic variety of disorders; in addition to the fact that MG symptoms may be vague, fluctuate or only affect certain muscles in mild or early cases. Thus, it is not unusual for a diagnosis of MG to be delayed or even misdiagnosed leading to unnecessary and potentially harmful therapeutic interventions, as well as to treatment delay and, hence, to increased morbidity [27].…”

Section: Discussionmentioning

confidence: 99%

The Utility of Concentric Needle Single Fiber Electromyography in Diagnosing Myasthenia Gravis

Nadeem¹

2021

OAJNN

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Introduction: Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disorder, characterized by varying degrees of fluctuating muscular weakness and fatigability. The diagnosis of MG can be difficult and, therefore, bed-side clinical testing, electrophysiological investigations; as well as serum antibodies tests are often used to establish the diagnosis. Objective:The aim of this study was to define the diagnostic accuracy of concentric needle electrode single fiber electromyography (CNE-SFEMG) jitter test in MG patients and to determine its' diagnostic value by calculating the sensitivity, specificity, predictive values and accuracy of the test.Methods: Retrospective analysis of 74 Omani MG patients' data was carried out to determine the diagnostic sensitivity, specificity and predictive values of CNE-SFEMG test; against a reference standard of MG by virtue of clinical features, antibody assay and response to treatment.Receiver Operating Characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was also calculated to measure the accuracy of the test. A comparison of the frequency of CNE-SFEMG abnormality between ocular (OMG) and generalized (GMG) myasthenia gravis patients was done.Results: Abnormal CNE-SFEMG results were detected in 79.1%, 77% and 82.4% of all MG, GMG and OMG patients respectively. Based on the reference standard used, the sensitivity, specificity and predictive values were determined, and the test accuracy was measured in all MG, GMG and OMG included patients. CNE-SFEMG had a sensitivity of 79.1 % and specificity of 51.6 % in all MG patients with 67.6% test accuracy. In GMG, CNE-SFEMG had a sensitivity of 76.9%, specificity of 35.7% and 62.5% accuracy of the test; while CNE-SFEMG for OMG cases showed a sensitivity of 82.4% and specificity of 64.7% with 73.5% test accuracy.The CNE-SFEMG abnormality was more frequent in the ocular than the generalized MG patients but with insignificant statistical difference. Conclusion:Our findings indicate that CNE-SFEMG is a very useful and valid test for MG and our results were comparable, but lower than previously published values.Significance: The sensitivities, specificity, predictive values and test accuracy of CNE-SFEMG jitter in the diagnosis of MG cases attending the neuromuscular unit at a tertiary care hospital in Muscat-Oman were documented.

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Section: Discussionmentioning

confidence: 99%

The Utility of Concentric Needle Single Fiber Electromyography in Diagnosing Myasthenia Gravis

Nadeem¹

2021

OAJNN

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“…2,3 and sometimes misdiagnosed 3,4,5 in the elderly because of the broad differential diagnoses from comorbidities in this age group. MG has been mistaken for hysteria, stroke, motor neurone and Parkinson's disease in the elderly.…”

Section: Late-onset Mg Has Been Underdiagnosedmentioning

confidence: 99%

“…MG has been mistaken for hysteria, stroke, motor neurone and Parkinson's disease in the elderly. 3,4,5 The differential diagnoses of oculobulbar syndrome with limb girdle weakness ranges from neuromuscular junctional disorder to myopathy, radiculopathy, central nervous system and psychiatric disorders. 4 Overlapping symptoms from comorbidities have led to no treatment, 2,3,4,5 inappropriate investigations (26%) 3 and sometimes harmful interventions.…”

Section: Late-onset Mg Has Been Underdiagnosedmentioning

confidence: 99%

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Delay and misdiagnosis in adult myasthenia gravis: A case report

Kwa¹

2016

IeJSME

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“…The diagnosis of MG is often slow and it is sometimes misdiagnosed [ 20 ]. There are significant variations in both medical treatment and settings of care, range from hospitals to long-term care facilities, and non-pharmacological treatments could be underused [ 21 , 22 ]. As a possible consequence, the quality of the life and the outcomes of the patients can be poor, and myasthenic crisis (MC) still affects 15–20% of MG patients, with a lethality of 3–8% [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a Model Care Pathway for Myasthenia Gravis

Payedimarri

Ratti

Rescinito

et al. 2021

IJERPH

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Myasthenia Gravis (MG) is a chronic, life-lasting condition that requires high coordination among different professionals and disciplines. The diagnosis of MG is often delayed and sometimes misdiagnosed. The goal of the care pathway (CP) is to add value to healthcare reducing unnecessary variations. The quality of the care received by patients affected with MG could benefit from the use of CP. We conducted a study aimed to define an inclusive, comprehensive, and multidisciplinary CP for the diagnosis, treatment, and care of MG. The development of the model CP, key interventions, and process indicators is based on the literature review and 85 international MG experts were involved in their evaluation, expressing a judgment of relevance through the Delphi study. 60 activities are included in the model CP and evaluated by the MG experts were valid and feasible. The 60 activities were then translated into 14 key interventions and 24 process indicators. We believe that the developed model CP will help for MG patients to have a timely diagnosis and high-quality, accessible, and cost-effective treatments and care. We also believe that the development of model CPs for other rare diseases is feasible and could aid in the integration of evidence-based knowledge into clinical practice.

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Misdiagnosis of Myasthenia Gravis and Subsequent Clinical Implication : A Case Report and Review of Literature

Cited by 12 publications

References 7 publications

The Utility of Concentric Needle Single Fiber Electromyography in Diagnosing Myasthenia Gravis

The Utility of Concentric Needle Single Fiber Electromyography in Diagnosing Myasthenia Gravis

Delay and misdiagnosis in adult myasthenia gravis: A case report

Development of a Model Care Pathway for Myasthenia Gravis

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