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Masseteric repetitive nerve stimulation in the diagnosis of myasthenia gravis

Published on Jun 1, 2001in Clinical Neurophysiology3.675
· DOI :10.1016/S1388-2457(01)00546-6
Giovanni Pavesi19
Estimated H-index: 19
(University of Parma),
Luigi Cattaneo26
Estimated H-index: 26
(University of Parma)
+ 1 AuthorsDomenico Mancia19
Estimated H-index: 19
(University of Parma)
Abstract
Abstract Objective : (1) to develop a method for masseteric repetitive nerve stimulation (RNS) and to obtain normative data for amplitude and area decrement of the muscle (M) response. (2) To investigate myasthenia gravis (MG) patients with masseteric RNS. Masticatory muscles are frequently affected in MG, but no RNS test is available to investigate this district. Methods : Fifteen healthy subjects and 17 MG patients were examined. The masseteric nerve was stimulated by a monopolar needle (cathode), inserted between the mandibular incisure and the zygomatic arch, and a surface electrode (anode), on the contralateral cheek. Masseteric M response was recorded using surface electrodes on the muscle belly and below the mandibular angle. Stimuli were delivered at 3 Hz in trains of 9, at rest and after isometric effort. Results : Normal subjects: mean amplitude decrement was 0.3±1.2% at rest, and 1.9±1.3% after isometric effort. Patients: 15 patients (88%) were positive on masseteric RNS; in 3 of these it was the only positive RNS test. The extent of decrement observed in masseter muscle was significantly greater than in trapezius muscle. Conclusions : Masseteric RNS is a simple and well-tolerated procedure; it offers a new possibility in testing the cranial muscles in disorders of neuromuscular transmission.
  • References (25)
  • Citations (28)
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References25
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Weak electrical stimuli delivered to the motor nerve supplying the masseter muscle (masseteric nerve) during voluntary contraction of jaw-closing muscles elicit, in humans, an H-reflex in the masseter (Godaux & Desmedt, 1975a; Cruccu et al. 1989) and temporalis muscles (Macaluso & De Laat, 1995). The activation of heteronymous Ia projections arising from the masseter muscle and directed to temporalis motoneurones elicits the pure reflex excitation of temporalis motoneurones with no antidromic in...
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#1F. G. WeijnenH-Index: 8
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Masticatory muscle strength was quantified in patients with bulbar myasthenia gravis and compared with that of patients with ocular myasthenia gravis, patients in clinical remission (whether or not pharmacological) who previously suffered from bulbar myasthenia gravis, and healthy subjects. Maximal bite force and maximal activity of the masseter and temporalis muscles and of the submental muscle complex were measured. Bite force was decreased in the patients with bulbar myasthenia gravis, but wa...
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The need for universally accepted classifications, grading systems, and methods of analysis for patients undergoing therapy for MG is widely recognized and is particularly needed for therapeutic research trials. The Medical Scientific Advisory Board (MSAB) of the Myasthenia Gravis Foundation of America (MGFA) formed a Task Force in May 1997 to address these issues. Initially, the Task Force planned to develop classifications and outcome measures pertaining only to standardizing thymectomy trials...
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An electric stimulation of the masseteric nerve elicits a heteronymous H-reflex in the temporal muscle. The characteristics of this reflex response were investigated by analysis of the firing probability changes of single motor units. Eleven healthy subjects participated in the experiments. The heteronymous H-reflex of the temporal muscle was electrically elicited by stimulation of the masseteric nerve at 120% of the intensity needed for the maximal masseteric M-wave. From 8 to 24 motor units we...
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