Initial Repetitive Nerve Stimulation Test Predicts Conversion of Ocular Myasthenia Gravis to Generalized Myasthenia Gravis
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Background and Purpose A major concern with ocular myasthenia gravis (MG) is the potential conversion to generalized MG. This study was conducted to determine if the repetitive nerve stimulation (RNS) test could predict the conversion from ocular to generalized MG. Methods The RNS test was conducted in a consistent manner on five muscles in the face and limbs in every patient. Subjects were divided into those who remained as ocular MG (ROMG group) and those who experienced conversion to generalized MG during follow-up (GOMG group). Results Conversion to generalized MG occurred in 24 (21.4%) of 112 MG patients with ocular onset. The proportion of patients displaying abnormal decreases in responses in the trapezius, abductor digiti minimi, or flexor carpi ulnaris muscles on the RNS test was higher in the GOMG group (p<0.001, p=0.002, and p<0.001, respectively). The Cox proportional-hazards model revealed that an abnormal result on the RNS test was significantly associated with conversion to generalized MG [hazard ratio (HR)=3.13, 95% confidence interval (CI)=1.18– 8.32]. Notably, the HR was higher for abnormal results on the RNS test for the limb muscles, at 5.19 (95% CI=2.09–12.90). Conclusions An abnormal result on the RNS test, especially in the limb muscles, is an independent predictor of the conversion from ocular to generalized MG. Applying the RNS test to limb muscles could be useful for predicting the conversion to generalized MG in patients with ocular onset.
Abstract
Background and Purpose A major concern with ocular myasthenia gravis (MG) is the potential conversion to generalized MG. This study was conducted to determine if the repetitive nerve stimulation (RNS) test could predict the conversion from ocular to generalized MG. Methods The RNS test was conducted in a consistent manner on five muscles in the face and limbs in every patient. Subjects were divided into those who remained as ocular MG (ROMG group) and those who experienced conversion to generalized MG during follow-up (GOMG group). Results Conversion to generalized MG occurred in 24 (21.4%) of 112 MG patients with ocular onset. The proportion of patients displaying abnormal decreases in responses in the trapezius, abductor digiti minimi, or flexor carpi ulnaris muscles on the RNS test was higher in the GOMG group (p<0.001, p=0.002, and p<0.001, respectively). The Cox proportional-hazards model revealed that an abnormal result on the RNS test was significantly associated with conversion to generalized MG [hazard ratio (HR)=3.13, 95% confidence interval (CI)=1.18– 8.32]. Notably, the HR was higher for abnormal results on the RNS test for the limb muscles, at 5.19 (95% CI=2.09–12.90). Conclusions An abnormal result on the RNS test, especially in the limb muscles, is an independent predictor of the conversion from ocular to generalized MG. Applying the RNS test to limb muscles could be useful for predicting the conversion to generalized MG in patients with ocular onset.
참고문헌 (22)
- Gilhus NE, "Myasthenia gravis", N Engl J Med, 375, pp.2570~2581 (2016)
- Gilhus NE, "Myasthenia gravis : subgroup classification and therapeutic strategies", Lancet Neurol, 14, pp.1023~1036 (2015)
- Grob D, "Lifetime course of myasthenia gravis", Muscle Nerve, 37, pp.141~149 (2008)
- Barton JJ, "Ocular aspects of myasthenia gravis", Semin Neurol, 20, pp.7~20 (2000)
- Bever CT Jr, "Prognosis of ocular myasthenia", Ann Neurol, 14, pp.516~519 (1983)
- Oosterhuis HJ, "The natural course of myasthenia gravis : a long term follow up study", J Neurol Neurosurg Psychiatry, 52, pp.1121~1127 (1989)
- Aguirre F, "Prognosis of ocular myasthenia gravis in an Argentinian population", Eur Neurol, 79, pp.113~117 (2018)
- Hong YH, "Prognosis of ocular myasthenia in Korea : a retrospective multicenter analysis of 202 patients", J Neurol Sci, 273, pp.10~14 (2008)
- Mazzoli M, "Factors affecting outcome in ocular myasthenia gravis", Int J Neurosci, 128, pp.15~24 (2018)
- Teo KY, "Low conversion rate of ocular to generalized myasthenia gravis in Singapore", Muscle Nerve, 57, pp.756~760 (2018)
- Allen JA, "Ocular myasthenia gravis in a senior population : diagnosis, therapy, and prognosis", Muscle Nerve, 41, pp.379~384 (2010)
- Sommer N, "Ocular myasthenia gravis : response to long-term immunosuppressive treatment", J Neurol Neurosurg Psychiatry, 62, pp.156~162 (1997)
- Weinberg DH, "Ocular myasthenia gravis : predictive value of single-fiber electromyography", Muscle Nerve, 22, pp.1222~1227 (1999)
- Ding J, "Prediction of generalization of ocular myasthenia gravis under immunosuppressive therapy in Northwest China", BMC Neurol, 20, pp.238~ (2020)
- Lo YL, "Effect of exercise on repetitive nerve stimulation studies : new appraisal of an old technique", J Clin Neurophysiol, 21, pp.110~113 (2004)
- Preston DC, "Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations", pp.57~60 (2013), Elsevier
- Abraham A, "Electrophysiological testing is correlated with myasthenia gravis severity", Muscle Nerve, 56, pp.445~448 (2017)
- Jaretzki A 3rd, "Myasthenia gravis : recommendations for clinical research standards", Ann Thorac Surg, 70, pp.327~334 (2000)
- Costa J, "Repetitive nerve stimulation in myasthenia gravis--relative sensitivity of different muscles", Clin Neurophysiol, 115, pp.2776~2782 (2004)
- Li F, "Generalization after ocular onset in myasthenia gravis : a case series in Germany", J Neurol, 265, pp.2773~2782 (2018)
- Huang X, "Clinical characteristics of juvenile myasthenia gravis in Southern China", Front Neurol, 9, pp.77~ (2018)
- Ogawa G, "A new maneuver for repetitive nerve stimulation testing in the trapezius muscle", Muscle Nerve, 47, pp.668~672 (2013)