对比研究正中神经和尺神经重复神经刺激在全身性重症肌无力中的应用。

Direct comparison of median and ulnar repetitive nerve stimulation in generalized myasthenia gravis.

机构信息

Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA.

出版信息

Muscle Nerve. 2021 Oct;64(4):490-493. doi: 10.1002/mus.27366. Epub 2021 Jul 14.

DOI:10.1002/mus.27366

PMID:34196418

Abstract

INTRODUCTION/AIMS: Ulnar nerve repetitive nerve stimulation (RNS) has been traditionally used in the electrophysiological evaluation of myasthenia gravis (MG). However, its low diagnostic sensitivity remains a limitation. Existing data may suggest that median nerve RNS outperforms that of the ulnar nerve, but a direct comparison is currently lacking. The aim of this study was to directly compare the diagnostic yields between median and ulnar nerve RNS in patients with generalized MG.

METHODS

We performed a retrospective analysis of patients with MG who underwent median and ulnar nerve RNS at a single tertiary center.

RESULTS

RNS studies of median nerve recording from the abductor pollicis brevis and ulnar nerve recording from the adductor digiti minimi were completed in 28 patients with generalized MG. Abnormal RNS was more frequently observed in the median compared with the ulnar nerve (60.7% vs 35.7%, P = .046). The average magnitude of decrement was higher in the median nerve compared with the ulnar nerve (17.3% vs 9.6%, P = .017). Differences between the median and ulnar nerve RNS studies were restricted to patients with mild manifestations (Myasthenia Gravis Foundation of America class II).

DISCUSSION

Median nerve RNS has superior diagnostic sensitivity as compared with ulnar nerve RNS in the assessment of mild generalized MG.

摘要

简介/目的：尺神经重复神经刺激（RNS）传统上用于重症肌无力（MG）的电生理评估。然而，其诊断灵敏度低仍然是一个限制。现有数据可能表明正中神经 RNS 优于尺神经 RNS，但目前缺乏直接比较。本研究旨在直接比较正中神经和尺神经 RNS 在全身性 MG 患者中的诊断效果。

方法

我们对在单一三级中心接受正中神经和尺神经 RNS 检查的 MG 患者进行了回顾性分析。

结果

对 28 例全身性 MG 患者进行了拇指外展短肌正中神经记录和小指内收肌尺神经记录的 RNS 研究。与尺神经相比，正中神经的异常 RNS 更常见（60.7%比 35.7%，P=.046）。与尺神经相比，正中神经的递减幅度更大（17.3%比 9.6%，P=.017）。正中神经和尺神经 RNS 研究之间的差异仅限于表现轻微的患者（美国重症肌无力基金会分类 II 级）。