Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome

Faye Y. Chiou-Tan, Richard W. Tim, James M. Gilchrist, Cheryl F. Weber, John R. Wilson, Timothy J. Benstead, Arlene M. Braker, James B. Caress, Sudhansu Chokroverty, Earl R. Hackett Md, Robert L. Harmon, Bernadette A. Hughes, Milind J. Kothari, Tim Lachman, Richard I. Malamut, Christina M. Marciniak, Robert G. Miller, Kevin R. Nelson, Richard K. Olney, Atul T. PatelCaroline A. Quartly, Karen S. Ryan

Research output: Contribution to journalReview article

115 Citations (Scopus)

Abstract

A retrospective literature review of the electrodiagnosis of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) through July 1998 was performed for the purpose of generating evidence-based practice parameters. There were 545 articles identified, of which 13 articles met at least three of the six criteria set previously by the American Association of Electrodiagnostic Medicine (AAEM). An additional 21 articles were identified from review articles or the references of these first 13 articles leading to a total of 34 articles. Results of studies utilizing repetitive nerve stimulation (RNS) showed that a 10% decrement in amplitude from the first to fourth or fifth intravolley waveform while stimulating at 2-5 Hz is valid for the diagnosis of MG. The degree of increment needed for the diagnosis of LEMS is at least 25% but most accurate when greater than 100%. Abnormal jitter or impulse blocking are the appropriate criteria for diagnosis of neuromuscular junction (NMJ) disorders when using single fiber electromyography (SFEMG). SFEMG is more sensitive than RNS for the diagnosis of disorders of neuromuscular transmission, but may be less specific and may not be available. Therefore, RNS remains the preferred initial test for MG and LEMS.

Original languageEnglish (US)
Pages (from-to)1239-1247
Number of pages9
JournalMuscle and Nerve
Volume24
Issue number9
DOIs
StatePublished - Jan 1 2001

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Lambert-Eaton Myasthenic Syndrome
Myasthenia Gravis
Neuromuscular Junction Diseases
Electromyography
Electrodiagnosis
Evidence-Based Practice
Medicine

All Science Journal Classification (ASJC) codes

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)

Cite this

Chiou-Tan, Faye Y. ; Tim, Richard W. ; Gilchrist, James M. ; Weber, Cheryl F. ; Wilson, John R. ; Benstead, Timothy J. ; Braker, Arlene M. ; Caress, James B. ; Chokroverty, Sudhansu ; Hackett Md, Earl R. ; Harmon, Robert L. ; Hughes, Bernadette A. ; Kothari, Milind J. ; Lachman, Tim ; Malamut, Richard I. ; Marciniak, Christina M. ; Miller, Robert G. ; Nelson, Kevin R. ; Olney, Richard K. ; Patel, Atul T. ; Quartly, Caroline A. ; Ryan, Karen S. / Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome. In: Muscle and Nerve. 2001 ; Vol. 24, No. 9. pp. 1239-1247.
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title = "Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome",
abstract = "A retrospective literature review of the electrodiagnosis of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) through July 1998 was performed for the purpose of generating evidence-based practice parameters. There were 545 articles identified, of which 13 articles met at least three of the six criteria set previously by the American Association of Electrodiagnostic Medicine (AAEM). An additional 21 articles were identified from review articles or the references of these first 13 articles leading to a total of 34 articles. Results of studies utilizing repetitive nerve stimulation (RNS) showed that a 10{\%} decrement in amplitude from the first to fourth or fifth intravolley waveform while stimulating at 2-5 Hz is valid for the diagnosis of MG. The degree of increment needed for the diagnosis of LEMS is at least 25{\%} but most accurate when greater than 100{\%}. Abnormal jitter or impulse blocking are the appropriate criteria for diagnosis of neuromuscular junction (NMJ) disorders when using single fiber electromyography (SFEMG). SFEMG is more sensitive than RNS for the diagnosis of disorders of neuromuscular transmission, but may be less specific and may not be available. Therefore, RNS remains the preferred initial test for MG and LEMS.",
author = "Chiou-Tan, {Faye Y.} and Tim, {Richard W.} and Gilchrist, {James M.} and Weber, {Cheryl F.} and Wilson, {John R.} and Benstead, {Timothy J.} and Braker, {Arlene M.} and Caress, {James B.} and Sudhansu Chokroverty and {Hackett Md}, {Earl R.} and Harmon, {Robert L.} and Hughes, {Bernadette A.} and Kothari, {Milind J.} and Tim Lachman and Malamut, {Richard I.} and Marciniak, {Christina M.} and Miller, {Robert G.} and Nelson, {Kevin R.} and Olney, {Richard K.} and Patel, {Atul T.} and Quartly, {Caroline A.} and Ryan, {Karen S.}",
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Chiou-Tan, FY, Tim, RW, Gilchrist, JM, Weber, CF, Wilson, JR, Benstead, TJ, Braker, AM, Caress, JB, Chokroverty, S, Hackett Md, ER, Harmon, RL, Hughes, BA, Kothari, MJ, Lachman, T, Malamut, RI, Marciniak, CM, Miller, RG, Nelson, KR, Olney, RK, Patel, AT, Quartly, CA & Ryan, KS 2001, 'Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome', Muscle and Nerve, vol. 24, no. 9, pp. 1239-1247. https://doi.org/10.1002/mus.1140

Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome. / Chiou-Tan, Faye Y.; Tim, Richard W.; Gilchrist, James M.; Weber, Cheryl F.; Wilson, John R.; Benstead, Timothy J.; Braker, Arlene M.; Caress, James B.; Chokroverty, Sudhansu; Hackett Md, Earl R.; Harmon, Robert L.; Hughes, Bernadette A.; Kothari, Milind J.; Lachman, Tim; Malamut, Richard I.; Marciniak, Christina M.; Miller, Robert G.; Nelson, Kevin R.; Olney, Richard K.; Patel, Atul T.; Quartly, Caroline A.; Ryan, Karen S.

In: Muscle and Nerve, Vol. 24, No. 9, 01.01.2001, p. 1239-1247.

Research output: Contribution to journalReview article

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T1 - Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome

AU - Chiou-Tan, Faye Y.

AU - Tim, Richard W.

AU - Gilchrist, James M.

AU - Weber, Cheryl F.

AU - Wilson, John R.

AU - Benstead, Timothy J.

AU - Braker, Arlene M.

AU - Caress, James B.

AU - Chokroverty, Sudhansu

AU - Hackett Md, Earl R.

AU - Harmon, Robert L.

AU - Hughes, Bernadette A.

AU - Kothari, Milind J.

AU - Lachman, Tim

AU - Malamut, Richard I.

AU - Marciniak, Christina M.

AU - Miller, Robert G.

AU - Nelson, Kevin R.

AU - Olney, Richard K.

AU - Patel, Atul T.

AU - Quartly, Caroline A.

AU - Ryan, Karen S.

PY - 2001/1/1

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JO - Muscle and Nerve

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SN - 0148-639X

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