title: New strategy for improving the diagnostic sensitivity of repetitive nerve stimulation in myasthenia gravis.
abstract: The diagnostic sensitivity of repetitive nerve stimulation (RNS) in patients with myasthenia gravis (MG) varies as a function of the number of muscles or the choice of muscles studied.
  
  
  
  By exploring 12 muscles bilaterally, we evaluated the global sensitivity of RNS at rest, the sensitivity in different clinical forms, and the sensitivity of different combinations of muscles studied.
  
  
  
  The global sensitivity of RNS was 82%, and specificity was 100%. The sensitivity in the MG subgroups was as follows: ocular (O) = 67%; oculobulbar (OB) = 86%; and generalized (G) = 89%. The most sensitive muscles were the anconeus in group O, orbicularis oculi (OO) or nasalis in group OB, and the trapezius in group G. Maximum sensitivity was obtained by exploring OO, trapezius, and anconeus bilaterally.
  
  
  
  We recommend bilateral exploration of at least 3 muscles, a facial muscle, trapezius, and anconeus. Muscle Nerve 55: 532-538, 2017.
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|INSERM U910 Aix-Marseille University, Marseille, France.
authors: Hanna
authors: H
authors: Bou Ali
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|INSERM U910 Aix-Marseille University, Marseille, France.|FILNEMUS, Filière nationale des maladies neuromusculaires, Marseille, France.
authors: Emmanuelle
authors: E
authors: Salort-Campana
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|INSERM U910 Aix-Marseille University, Marseille, France.
authors: Aude Marie
authors: AM
authors: Grapperon
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.
authors: Julien
authors: J
authors: Gallard
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.
authors: Jerome
authors: J
authors: Franques
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|FILNEMUS, Filière nationale des maladies neuromusculaires, Marseille, France.
authors: Amandine
authors: A
authors: Sevy
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|FILNEMUS, Filière nationale des maladies neuromusculaires, Marseille, France.
authors: Emilien
authors: E
authors: Delmont
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|FILNEMUS, Filière nationale des maladies neuromusculaires, Marseille, France.
authors: Annie
authors: A
authors: Verschueren
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|INSERM U910 Aix-Marseille University, Marseille, France.|FILNEMUS, Filière nationale des maladies neuromusculaires, Marseille, France.
authors: Jean
authors: J
authors: Pouget
authors: Reference Center for Neuromuscular Disorders and ALS, Timone University Hospital, 264 rue Saint-Pierre, Marseille, Cedex, 05 13385, France.|INSERM U910 Aix-Marseille University, Marseille, France.|FILNEMUS, Filière nationale des maladies neuromusculaires, Marseille, France.
authors: Shahram
authors: S
authors: Attarian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography; D005229:Fatty Acids, Monounsaturated / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009157:Myasthenia Gravis / Q000175:diagnosis*; D009460:Neurologic Examination; D011950:Receptors, Cholinergic / Q000276:immunology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D005229:Fatty Acids, Monounsaturated; D011950:Receptors, Cholinergic; C008563:musk
keywords: decrement; diagnosis; myasthenia; myasthenia gravis; repetitive nerve stimulation sensitivity