Lu dans le livre des résumés des présentations faites lors du congrès "13éme journées de la Société Française de Myologie SFM" tenu à l'Ecole Normale Supérieure de Lyon les 23-24 & 25 Novembre 2015 http://www.congresjsfm.org/?q=fr/node/15
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Improving the diagnostic sensitivity of repetitive nerve stimulation in myasthenia gravis
Hanna Bou Ali (1), Emmanuelle Salort-Campana (1), Annie Verschueren (1), Julien Gallard (1), Jerome Franques (1), Aude Marie Grapperon(1), Jean Pouget (1), Shahram Attarian (1)
Centre de référence des maladies neuromusculaires et de la SLA, La Timone hospital, Aix marseille university, Marseille, France
To determine the diagnostic sensitivity and specificity of repetitive nerve stimulation (RNS) of 12 muscles in patients with myasthenia gravis (MG).
Forty five patients suspected for MG were enrolled consecutively. Twenty-‐two patients had clinical signs and laboratory test results consistent with MG (MG group). The others served as a pathological control group. Six nerve-‐muscle couples were studied on both sides of all subjects using RNS. The MG group patients were divided into three subgroups according to the prominent symptoms: group O (ocular), group OB (bulbar or oculo-‐bulbar), and group G (generalized).
In the MG group, 33% of the decrements were unilateral. The global sensitivity of RNS was 82% and specificity was 100%. The sensitivity in the MG subgroups was as follows: group O = 67%, group OB = 86%, and group G = 89%. The most sensitive muscles were the anconeus in group O (50%), the orbicularis oculi or nasalis in group OB (71%), and the trapezius in group G (78%).
The diagnostic sensitivity of RNS in myasthenia clearly improved by increasing the number of tested muscles. We recommend the systematic bilateral exploration of at least three muscles: a facial muscle, the trapezius, and the anconeus.