Evidence map›Paper›PMID 38669629›Full record

Trial reportNeurology2024

Accuracy of Repetitive Ocular Vestibular-Evoked Myogenic Potentials to Diagnose Myasthenia Gravis in Patients With Ptosis or Diplopia.

Yulia Valko, Magdalena A Wirth, Fabienne C Fierz, Marianne K Schesny, Sally Rosengren, Tanja Schmückle-Meier, Christopher J Bockisch, Dominik Straumann, Bettina Schreiner, Konrad P Weber

Registry-linked trialOpen access · hybridAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03049956 (Diagnostic Accuracy of Repetitive Ocular Vestibular Evoked Myogenic Potentials in Myasthenia Gravis), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03049956 nacompletednot on this map

Diagnostic Accuracy of Repetitive Ocular Vestibular Evoked Myogenic Potentials in Myasthenia Gravis (OMG Study)

TypeinterventionalSponsorUniversity of ZurichRan2016Enrolled96ConditionsMyasthenia Gravis, OcularArmsOcular vestibular evoced myogenic potentials
3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 4 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Yulia ValkoFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.ORCID 0000-0002-6147-1960
Magdalena A WirthFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Fabienne C FierzFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Marianne K SchesnyFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Sally RosengrenFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Tanja Schmückle-MeierFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Christopher J BockischFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Dominik StraumannFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Bettina SchreinerFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.
Konrad P WeberFrom the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia.ORCID 0000-0003-2526-4582
University of Zurich · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesWe developed repetitive ocular vestibular-evoked myogenic potentials (roVEMP) as an electrophysiologic test that allows us to elicit the characteristic decrement of extraocular muscles in patients with ocular myasthenia gravis (OMG). Case-control studies demonstrated that roVEMP reliably differentiates patients with OMG from healthy controls. We now aimed to evaluate the diagnostic accuracy of roVEMP for OMG diagnosis in patients with ptosis and/or diplopia.

methodsIn this blinded prospective diagnostic accuracy trial, we compared roVEMP in 89 consecutive patients presenting with ptosis and/or diplopia suspicious of OMG with a multimodal diagnostic approach, including clinical examination, antibodies, edrophonium testing, repetitive nerve stimulation of accessory and facial nerves, and single-fiber EMG (SFEMG). We calculated the roVEMP decrement as the ratio between the mean of the first 2 responses compared with the mean of the sixth-ninth responses in the train and used cutoff of >9% (unilateral decrement) in a 30 Hz stimulation paradigm.

resultsFollowing a complete diagnostic work-up, 39 patients (44%) were diagnosed with ocular MG, while 50 patients (56%) had various other neuro-ophthalmologic conditions, but not MG (non-MG). roVEMP yielded 88.2% sensitivity, 30.2% specificity, 50% positive predictive value (PPV), and 76.5% negative predictive value (NPV). For comparison, SFEMG resulted in 75% sensitivity, 56% specificity, 55.1% PPV, and 75.7% NPV. All other diagnostic tests (except for the ice pack test) also yielded significantly higher positive results in patients with MG compared with non-MG. DISCUSSION: The study revealed a high sensitivity of 88.2% for roVEMP in OMG, but specificity and PPV were too low to allow for the OMG diagnosis as a single test. Thus, differentiating ocular MG from other neuro-ophthalmologic conditions remains challenging, and the highest diagnostic accuracy is still obtained by a multimodal approach. In this study, roVEMP can complement the diagnostic armamentarium for the diagnosis of MG. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with diplopia and ptosis, roVEMP alone does not accurately distinguish MG from non-MG disorders. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov: NCT03049956.

Indexed as

BlepharoptosisDiplopiaMyasthenia GravisVestibular Evoked Myogenic PotentialsAdultAgedElectromyographyFemaleHumansMaleMiddle AgedOculomotor MusclesProspective StudiesSensitivity and SpecificityYoung Adult

Identifiers

PMID38669629
PMCPMC11398977
OpenAlexW4395685465

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.