ArticleClinical neurophysiology practice2026
Enhancing the diagnostic yield of myasthenia gravis using 7-Hz repetitive nerve stimulation: an 11-year retrospective study.
Article in Clinical neurophysiology practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the diagnostic utility of augmenting the conventional 3-Hz repetitive nerve stimulation test (RNST) with a 7-Hz protocol in patients with myasthenia gravis (MG). Methods: We retrospectively analyzed 11 years of RNST data (2013-2023) from patients at a tertiary medical center. The diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of the conventional 3-Hz protocol was compared against a combined 3-Hz plus 7-Hz protocol. Results: Among 311 MG patients (208 generalized MG [gMG]; 103 ocular MG [oMG]), adding 7-Hz stimulation significantly improved the sensitivity for gMG from 69.0% to 82.1% without compromising specificity (91.7%). Multivariable regression confirmed that the combined protocol was independently associated with higher diagnostic yield in gMG (OR = 2.28, Conclusion: Incorporating 7-Hz RNST into standard diagnostic algorithms substantially enhances the detection of gMG, particularly when conventional 3-Hz testing yields negative results in proximal muscles. Significance: RNST protocol selection may be tailored by clinical phenotype to maximize sensitivity by adding 7 Hz RNST.
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