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Initial Repetitive Nerve Stimulation Test Predicts Conversion of Ocular Myasthenia Gravis to Generalized Myasthenia Gravis

Journal of Clinical Neurology 2021년 17권 2호 p.265 ~ 272
김기훈, 김승우, 신하영,
소속 상세정보
김기훈 ( Kim Ki-Hoon ) - Yonsei University College of Medicine Department of Neurology
김승우 ( Kim Seung-Woo ) - Yonsei University College of Medicine Department of Neurology
신하영 ( Shin Ha-Young ) - Yonsei University College of Medicine Department of Neurology

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.

키워드

ocular myasthenia gravis; generalized myasthenia gravis; repetitive nerve stimulation test

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