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Warnecke T, Im S, Labeit B, Zwolinskaya O, Suntrup-Krüger S, Oelenberg S, Ahring S, Schilling M, Meuth S, Melzer N, Wiendl H, Ruck T, Dziewas R. Detecting myasthenia gravis as a cause of unclear dysphagia with an endoscopic tensilon test. Ther Adv Neurol Disord 2021; 14:17562864211035544. [PMID: 34394727 PMCID: PMC8361548 DOI: 10.1177/17562864211035544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
Aims: The flexible endoscopic evaluation of swallowing-tensilon test (FTT) was developed to diagnose myasthenia gravis (MG) in patients with unclear pharyngeal dysphagia. The purpose of this study was to determine sensitivity and specificity of the FTT and compare its diagnostic validity with that of other diagnostic markers. Methods: In this single-centre pragmatic clinical cohort study, a total of 100 patients with unclear pharyngeal dysphagia were eligible to undergo FTT. All patients were subjected to FTT and subsequently followed up clinically. FTT was considered positive if a significant improvement of pharyngeal swallowing function could be objectified endoscopically upon administration of edrophonium chloride. In addition, repetitive nerve stimulation test and serum MG antibody analysis were conducted. Results: All subjects (mean age 62.5 ± 14.1 years, female 33) underwent FTT without any complications. According to the results of the diagnostic procedures and based on long-term clinical follow-up for at least 3 years, 51 patients were finally diagnosed with MG. The sensitivity and specificity for the FTT was 88.2% and 95.9%, respectively. Application of the Cochran’s Q test showed statistically significant heterogeneity among the diagnostic tests, with results indicating FTT performance to be more accurate than the repetitive nerve stimulation results (p < 0.001) and comparable with serum antibody tests (p > 0.99). Conclusion: FTT has excellent clinical properties to be used routinely in the assessment of dysphagia with isolated or predominant pharyngeal muscle involvement allowing rapid and accurate diagnosis of MG.
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Affiliation(s)
- Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, Münster, 48149, Germany
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Olga Zwolinskaya
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Sonja Suntrup-Krüger
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Stephan Oelenberg
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Sigrid Ahring
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Matthias Schilling
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Sven Meuth
- Department of Neurology, Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
| | - Nico Melzer
- Department of Neurology, Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrueck, Osnabrueck, Germany
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