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Clinical and CN-SFEMG evaluation of neostigmine test in myasthenia gravis

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Abstract

Neostigmine test (NT) is a pharmacological test, demonstrating a clinical improvement in patients affected by myasthenia gravis (MG). We aim to compare clinical evaluation and neurophysiological recordings by concentric-needle single-fiber electromyography (CN-SFEMG) in response to acute administration of neostigmine in ocular and generalized MG patients. Twenty-three MG patients (10 with ocular MG and 13 with generalized MG) were evaluated before and after 90 min neostigmine 0.5-mg administration. Clinical responsiveness was assessed by MG composite (MGC) scale. Neurophysiological evaluation by CN-SFEMG considered analysis of mean value of consecutive differences (MCD), single-pair jitter, and blocks. MGC scores significantly improved after NT in generalized MG patients (MGC 11.1 ± 7.6 vs 9.1 ± 6.7, p = 0.02), whereas the improvement was not significant in the ocular group. CN-SFEMG recordings significantly improved after NT in generalized MG patients (MCD 58.9 ± 18.8 vs 45.9 ± 23.2 μs, p = 0.003; single-pair jitter 49.8 ± 26.9 vs 24.1 ± 26.7%, p = 0.0001; blocks 6.2 ± 9.5 vs 2.6 ± 7.4%, p = 0.03) as well as in ocular MG patients (MCD 50.8 ± 22.7 vs 40.1 ± 22.9 μs, p = 0.01; single-pair jitter 35.9 ± 23.7 vs 20.0 ± 25.1%, p = 0.001). CN-SFEMG is a reliable tool to evaluate responsiveness to acute administration of neostigmine in MG. Moreover, neurophysiological modifications to NT could show subclinical improvement in ocular MG better than that of the clinical scale.

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Authors and Affiliations

  1. Department “G. F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy

    Giorgia Sciacca, Ester Reggio, Giovanni Mostile, Alessandra Nicoletti & Mario Zappia

  2. Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy

    Filippo Drago & Salvatore Salomone

Authors
  1. Giorgia Sciacca
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  2. Ester Reggio
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  3. Giovanni Mostile
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  4. Alessandra Nicoletti
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  5. Filippo Drago
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  6. Salvatore Salomone
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  7. Mario Zappia
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Correspondence to Mario Zappia.

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The study was approved by the Local Ethic Committee and patients were enrolled only after they signed the written informed consent.

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The authors declare that they have no conflict of interest.

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Sciacca, G., Reggio, E., Mostile, G. et al. Clinical and CN-SFEMG evaluation of neostigmine test in myasthenia gravis. Neurol Sci 39, 341–345 (2018). https://doi.org/10.1007/s10072-017-3194-0

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  • DOI: https://doi.org/10.1007/s10072-017-3194-0

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