The Anti-Acetylcholine Receptor Antibody Test in Suspected Ocular Myasthenia Gravis

Lee, Jung‐Jin; Koh, Kyung Min; Kim, Ungsoo

doi:10.1155/2014/689792

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Looking at the pattern of diplopia, it can be seen that horizontal diplopia is more common than vertical diplopia, so there is more affected of horizontal extraocular muscle such as other reports in OMG. [11,12] Moreover, the 57.1% AchR Ab positivity rate was similar to that in previous reports (50%-60%). [4,13] Positive results group showed 2 more clinical ocular symptoms (both ptosis and diplopia), than the group with negative results.…”

Section: Discussionsupporting

confidence: 89%

Ophthalmologic clinical features of ocular myasthenia gravis

Kim

Roh

2023

Medicine

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To investigate the clinical features of ocular myasthenia gravis (OMG) in ophthalmology. A total of 28 patients with ptosis or diplopia who were followed for at least 6 months between March 2016 and February 2022 were included in this study. The clinical symptoms of the patients and test results were analyzed. According to the positivity of serologic or electrophysiologic test, these patients were divided into 2 groups (positive and negative OMG results) and according to the clinical symptoms of diplopia or ptosis for comparison. Ptosis, diplopia, and both ptosis and diplopia were present in 6 (21.43%), 14 (50.0%), and 8 (28.57%) patients, respectively. Acetylcholine receptor auto-antibody (AchR Ab) was positive in 16 (57.14%) of 28 patients and the ice test was positive in 13 (92.86%) of 14 patients with ptosis. Abnormal thymic lesions were presented in 7 (25.0%) patients, and a definite improvement in response to pyridostigmine was observed in 27 (100.0%) patients. Both ptosis and diplopia were significantly higher in the group with positive results than that in the negative results group ( P = .025). In addition, both horizontal and vertical diplopia was significantly higher in the group with AchR Ab titer > 5.0 than that in the group with AchR Ab titer < 5.0 ( P = .041). After excluding cranial nerve palsy, if there is ptosis and diplopia, especially vertical diplopia, the possibility of OMG should be considered.

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Section: Discussionsupporting

confidence: 89%

Ophthalmologic clinical features of ocular myasthenia gravis

Kim

Roh

2023

Medicine

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“…However, 80% of those diagnosed with OMG were AChR binding Abs seropositive. Conventionally, AChR-Abs testing is considered to have a low sensitivity for diagnosing OMG, with some studies suggesting approximately 44%-66% and other studies suggesting 14.1% (7)(8)(9). However, a recent, large observational cohort study demonstrated 70.9% sensitivity in AChR binding Abs testing (2).…”

Section: Discussionmentioning

confidence: 99%

“…However, 80% of those diagnosed with OMG were AChR binding Abs seropositive. Conventionally, AChR–Abs testing is considered to have a low sensitivity for diagnosing OMG, with some studies suggesting approximately 44%–66% and other studies suggesting 14.1% (7–9).…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of Anti-acetylcholine Receptor Binding Antibody Testing in Diagnosing Ocular Myasthenia Gravis

Chung

Sheth²,

Wells³

et al. 2020

Journal of Neuro-Ophthalmology

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Background: Anti-acetylcholine receptor antibody (AChR-Abs) testing is a safe and simple ancillary method for confirming the diagnosis of myasthenia gravis. Despite the test's high sensitivity (85%-90%) for generalized myasthenia gravis, AChR-Abs testing has been reported to have a low sensitivity 44%-66% for ocular myasthenia gravis (OMG). The aim of the study is to assess the effectiveness of AChR binding Abs testing for diagnosing OMG by evaluating the test's sensitivity, specificity, positive predictive value, and negative predictive value. Methods: A retrospective chart review on 114 OMG suspects who presented to the emergency department of a tertiary eye center in Victoria, Australia, was completed. The patients presented with diplopia alone, ptosis alone, or the combination of diplopia and ptosis. All participants were followed up longitudinally in the neuro-ophthalmology outpatient clinics for the average of 2.8 months, where they have received AChR binding testing. The final diagnosis was only given to the patients who either were seropositive for AChR binding Abs and had a high clinical suspicion of OMG, or the patient who was seronegative for AChR binding Abs but was regarded as likely to have OMG clinically and responded to the diagnostic treatments (pyridostigmine bromide and immunosuppressant therapy). Results: The sensitivity of AChR binding Abs testing in diagnosing OMG was higher (80%; 95% confidence interval [CI], 51.91%-95.67%) than previously reported (44%-66%). AChR binding Abs testing also had a high specificity (98.99%; 95% CI, 94.50%-99.97%) and positive predictive value (92.31%; 95% CI, 62.68%-98.85%). Conclusion:The study suggests the higher utility of the AChR binding Abs testing in diagnosing OMG due to its high sensitivity, specificity, and positive predictive value.

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“…"Fluctuation, " the hallmark of the disease and its clinical signs, often impedes the diagnostic process. Moreover, serologic antibody testing, as well as repetitive nerve stimulation of peripheral muscles is reported to be less sensitive in OMG as compared to generalized myasthenia gravis (MG), with sensitivity rates of approximately 50% vs. up to 90% (6)(7)(8)(9)(10)(11)(12). Edrophonium testing may cause fatal adverse events and is often unavailable outside specialized institutions.…”

Section: Ocular Myasthenia Gravis -A Diagnostic Challengementioning

confidence: 99%

Diagnosing Myasthenia Gravis With Repetitive Ocular Vestibular Evoked Myogenic Potentials

et al. 2020

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Timely and accurate diagnosis of myasthenia gravis, particularly in patients with fluctuating, isolated ocular involvement, remains challenging. Serological antibody testing and repetitive nerve stimulation of peripheral muscles usually have low sensitivity in these patients. Edrophonium testing may cause adverse events, single-fiber electromyography (SFEMG) is time-consuming and both tests are often unavailable outside specialized institutions. Repetitive ocular vestibular evoked myogenic potential (roVEMP) stimulation has recently been introduced to facilitate the diagnosis of myasthenia gravis. Similar to repetitive nerve stimulation, roVEMPs detect muscle decrements with the benefit of being non-invasive and allowing for direct measurement of the extraocular muscles. This review summarizes the clinical evidence of the diagnostic value of roVEMP for myasthenia. Prospective clinical trials have demonstrated high sensitivity and specificity. RoVEMPs are of particular interest in challenging myasthenia subgroups with isolated ocular involvement, negative serology, and/or negative conventional electrophysiological results. Optimal roVEMP repetition rates of 20-30 Hz have been identified. This promising novel diagnostic tool merits further attention and investigation to establish its value as a clinical test for myasthenia.

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The Anti-Acetylcholine Receptor Antibody Test in Suspected Ocular Myasthenia Gravis

Cited by 3 publications

References 17 publications

Ophthalmologic clinical features of ocular myasthenia gravis

Ophthalmologic clinical features of ocular myasthenia gravis

The Usefulness of Anti-acetylcholine Receptor Binding Antibody Testing in Diagnosing Ocular Myasthenia Gravis

Diagnosing Myasthenia Gravis With Repetitive Ocular Vestibular Evoked Myogenic Potentials

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