Repetitive nerve stimulation of facial muscles in musk antibody–positive myasthenia gravis

Oh, Shin J.; Hatanaka, Y.; Hemmi, Shoji; Young, Angela M.; Scheufele, Mia; Nations, Sharon P.; Liang, Lu; Claussen, Gwen C.; Wolfe, Gil I.

doi:10.1002/mus.20498

Cited by 70 publications

(60 citation statements)

References 14 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The orbicularis oculi (O.O.) is the most frequently used facial muscle for RNS with a diagnostic yield of 75–85% in generalized MG [6,7]. The nasalis is also frequently used with a diagnostic yield of 52–67% [8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Repetitive Nerve Stimulation of Facial and Hypothenar Muscles: Relative Sensitivity in Different Myasthenia Gravis Subgroups

Kokotis¹,

Karandreas²

2011

Eur Neurol

View full text Add to dashboard Cite

Aim: To assess the utility of repetitive nerve stimulation (RNS) in facial and hypothenar muscles in the clinical groups of myasthenia gravis (MG). Patients and Methods: We performed RNS study in the orbicularis oculi (O.O.), nasalis and abductor digiti quinti (ADQ) in 115 consecutive myasthenic patients and classified them according to the classifications of the Myasthenia Gravis Foundation of America. Patients were classified into three groups: group 1, group 2 (IIa, IIIa and IVa) and group 3 (IIb, IIIb and IVb). Results: RNS was abnormal in 95 patients (82.6%): 78.3% in the O.O., 66.1% in the nasalis and 19.1% in the ADQ. Both facial muscles were statistically more sensitive than the ADQ in all groups of patients. RNS in the O.O. was more frequently abnormal than in the nasalis only in group 1. Sensitivity to acetylcholine antibodies in myasthenic patients was 84%. Acetylcholine receptor (AChR) and muscle-specific tyrosine kinase antibodies were present in 96.7% of the patients with abnormal RNS in both facial muscles. Single-fiber electromyogram (SFEMG) was abnormal in 91.3% of the tested patients. One of the three tests used for the diagnosis of MG (AChR antibodies, SFEMG, RNS) was abnormal in 99.1% of the patients. Discussion: O.O. is the most sensitive muscle in all groups of MG followed by nasalis, while the ADQ is the muscle with the lowest sensitivity. Facial muscles, especially the O.O., should be the first to be tested in MG. The negativity of all tests (RNS, AChR antibodies, SFEMG) should question the diagnosis of MG, even in the presence of symptoms consistent with MG.

show abstract

Section: Introductionmentioning

confidence: 99%

Repetitive Nerve Stimulation of Facial and Hypothenar Muscles: Relative Sensitivity in Different Myasthenia Gravis Subgroups

Kokotis¹,

Karandreas²

2011

Eur Neurol

View full text Add to dashboard Cite

show abstract

“…In a previous report, decremental responses of RNS in the orbicularis oculi muscles were more useful than those in the limb muscles of MuSK-MG patients (11). However, decremental responses of RNS can also occur in the denervated muscles of ALS patients (12); therefore, anti-MuSK antibodies must be evaluated for the establishment of an accurate diagnosis.…”

Section: Discussionmentioning

confidence: 92%

Anti-MuSK Antibody-positive Myasthenia Gravis Mimicking Amyotrophic Lateral Sclerosis

et al. 2015

View full text Add to dashboard Cite

We herein investigated the clinical features of three patients with anti-muscle-specific tyrosine kinase (MuSK) antibody-positive myasthenia gravis (MG), which was initially difficult to distinguish from amyotrophic lateral sclerosis (ALS). The patients exhibited dropped head syndrome or dysphagia as initial symptoms. Although their clinical findings were compatible with the revised El Escorial Criteria for ALS, their progression appeared to be more rapid than that of ALS. Both the edrophonium and repetitive nerve stimulation tests yielded negative results, and diurnal fluctuation was not confirmed. The patients were ultimately diagnosed with anti-MuSK antibody-positive MG. We therefore recommend the measurement of antiMuSK antibodies when encountering such cases.

show abstract

“…An abnormality of the spinal cord due to trauma, poliomyelitis or motor AChR-MG and 22 anti-MuSK and AchR-antibody-negative MG patients 20 .…”

Section: Discussionmentioning

confidence: 99%

Muscle-specific tyrosine kinase-antibody-positive myasthenic crisis with detailed electrophysiologic studies

Yanagawa

Hongo²,

Shiozaki³

et al. 2009

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

A sixty-nine-year-old male who presented in a coma due to sudden respiratory arrest was transferred to our hospital. After endotracheal intubation with manual ventilation, he became alert and his neurological findings were within the normal range, except for palsy of the respiratory muscles. Biochemical analyses of the blood and brain computed tomography failed to indicate the cause of the respiratory arrest. An edrophonium test did not improve the respiratory arrest. An urgent electromyogram at the dorsal interossei, biceps and sternocleidomastoideus muscle and a repetitive nerve stimulation test at the trapezius and deltoid muscle were also negative on the 1 st hospital day. After obtaining his detail past history which revealed double vision at 57 years old, weakness of muscle strength of the neck, dysphagia and sleep apnea at 67 years old, the electrophysiological study was performed on the 16 th day in the hospital.A repetitive nerve stimulation test at the levator labii superioris alaeque nasi showed a waning phenomenon.Moreover, single fiber electromyography showed an abnormal jitter at the frontal muscle. These results indicated a diagnosis of myasthenia gravis (MG). His anti-acetylcholine receptor (AChR) antibody was found to be negative, but anti-muscle-specific tyrosine kinase (MuSK) antibody was positive. After treatment with plasmapheresis and predonisolone, he regained normal respiratory function. He was discharged after 72 days with no neurological deficits.Anti-MuSK-antibody-positive MG tends to be associated with a 4

show abstract

Repetitive nerve stimulation of facial muscles in musk antibody–positive myasthenia gravis

Cited by 70 publications

References 14 publications

Repetitive Nerve Stimulation of Facial and Hypothenar Muscles: Relative Sensitivity in Different Myasthenia Gravis Subgroups

Repetitive Nerve Stimulation of Facial and Hypothenar Muscles: Relative Sensitivity in Different Myasthenia Gravis Subgroups

Anti-MuSK Antibody-positive Myasthenia Gravis Mimicking Amyotrophic Lateral Sclerosis

Muscle-specific tyrosine kinase-antibody-positive myasthenic crisis with detailed electrophysiologic studies

Contact Info

Product

Resources

About