Amandusson Åsa, Elf Kristin, Grindlund Margareta E, Punga Anna R
Department of Neuroscience, Clinical Neurophysiology, Uppsala University Hospital and Uppsala University, Uppsala, Sweden.
J Clin Neurophysiol. 2017 Sep;34(5):400-407. doi: 10.1097/WNP.0000000000000398.
Optimizing the diagnostic utility of repetitive nerve stimulation in myasthenia gravis (MG) may include tailoring the examination to clinical phenotype. Therefore, we analyzed all available repetitive nerve stimulation parameters in a large cohort of patients with confirmed MG diagnosis.
All repetitive nerve stimulation examinations at the Uppsala University Hospital rendering an MG diagnosis during 1996 to 2014 were analyzed. The deltoid, trapezius, anconeus, nasalis, abductor digiti quinti, and frontalis muscles were examined.
Two hundred one patients with MG were diagnosed. Abnormal amplitude decrement was found in 54% of patients with ocular MG, 77% of patients with predominantly bulbar fatigue, and in 83% of patients with predominantly limb fatigue. The deltoid muscle had the highest sensitivity in all MG subtypes, with a mean of 77% sensitivity in all clinical subtypes, and the most pronounced decrement for amplitude (P = 0.0002) and area (P < 0.0001). Technical issues were rare.
These data contribute to further optimization of repetitive nerve stimulation strategies regarding muscle selection and technical performance in the electrodiagnostic workup of MG.
优化重症肌无力（MG）重复神经刺激的诊断效用可能包括根据临床表型调整检查。因此，我们分析了一大群确诊为MG的患者的所有可用重复神经刺激参数。
分析了1996年至2014年期间在乌普萨拉大学医院进行的所有导致MG诊断的重复神经刺激检查。对三角肌、斜方肌、肘肌、鼻肌、小指展肌和额肌进行了检查。
确诊201例MG患者。在54%的眼肌型MG患者、77%的以延髓肌疲劳为主的患者和83%的以肢体疲劳为主的患者中发现异常波幅递减。三角肌在所有MG亚型中敏感性最高，在所有临床亚型中的平均敏感性为77%，波幅（P = 0.0002）和面积（P < 0.0001）下降最为明显。技术问题很少见。
这些数据有助于进一步优化MG电诊断检查中关于肌肉选择和技术操作的重复神经刺激策略。
