Comparison of ice pack test and single-fiber EMG diagnostic accuracy in patients referred for myasthenic ptosis
| Autor: | Corrado Zenesini, Rocco Liguori, Vincenzo Donadio, Matteo Paolucci, Maria Pia Giannoccaro, Vitantonio Di Stasi, Patrizia Avoni |
|---|---|
| Přispěvatelé: | Giannoccaro M.P., Paolucci M., Zenesini C., Di Stasi V., Donadio V., Avoni P., Liguori R. |
| Rok vydání: | 2020 |
| Předmět: |
IPT
medicine.medical_specialty Ocular myasthenia Single fiber emg ice pack test ocular myasthenia Diagnostic accuracy Gastroenterology 03 medical and health sciences 0302 clinical medicine Ptosis Internal medicine parasitic diseases 0502 economics and business medicine In patient Receiver operating characteristic business.industry 05 social sciences medicine.disease Predictive value Confidence interval single fiber EMG 050211 marketing Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Neurology. 95:e1800-e1806 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000010619 |
| Popis: | ObjectiveTo compare the diagnostic accuracy of ice pack test (IPT) and single-fiber EMG (SF-EMG) in patients with suspected ocular myasthenia (OM) presenting with ptosis.MethodsWe studied consecutive patients referred for the clinical suspicion of OM. Patients underwent IPT and stimulated SF-EMG on the orbicularis oculi muscle. Receiver operating characteristic curve analysis was performed to determine the accuracy of IPT, SF-EMG, and their combination.ResultsWe included 155 patients, 102 with OM and 53 with other diagnosis (OD). The IPT had a sensitivity of 86% (95% confidence interval [CI] 79–93) and a specificity of 79% (95% CI 68–90). SF-EMG showed a sensitivity of 94% (95% CI 89–98) and a specificity of 79% (95% CI 68–90). Overall, IPT and SF-EMG showed discordant results in 30 cases, 16 OM and 14 OD. The combination of IPT and SF-EMG, using the positivity of at least one test for OM diagnosis, increased the sensitivity to 98% (95% CI 95–100), reducing the specificity to 66% (95% CI 53–78), whereas using the positivity of both tests, we obtained a sensitivity of 82% (95% CI 75–90) and a specificity of 92% (95% CI 85–99). The negativity of both tests had a 94% (95% CI 87–100) negative predictive value. Comparison of the areas under the curve showed no differences in the diagnostic accuracy of IPT, SF-EMG, and their combinations.ConclusionsIPT and SF-EMG have similar diagnostic accuracy in patients with OM presenting with ptosis. The negativity of both tests strongly suggests another diagnosis.Classification of evidenceThis study provides Class I evidence that both the IPT and SF-EMG accurately identify patients with OM. |
| Databáze: | OpenAIRE |
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