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Electrophysiologic diagnosis of myasthenia gravis and the regional curare test

From the Departments of Neurology, Medicine, and Surgery and the Myasthenia Gravis Clinic and Laboratory of the Mount Sinai Hospital and School of Medicine of the City University of New York, New York.

Two hundred and fifty consecutive patients were evaluated for myasthenia gravis with repetitive supramaximal stimulation of peripheral nerves and regional curare administration when necessary. Among patients with definite generalized myasthenia gravis, 72 percent had abnormal responses to repetitive supramaximal stimulation alone and another 17 percent had abnormal responses after regional curare administration. Among those with possible generalized myasthenia gravis, 15 percent had abnormal responses to repetitive supramaximal stimulation and another 12 percent had abnormal responses after regional curare administration. Of those with only ocular symptoms, 46 percent had abnormal responses to repetitive supramaximal stimulation before or after regional curare administration, suggesting generalized involvement. Myasthenia gravis has not developed subsequently in any of the equivocal patients with negative electric tests. We have found these electric procedures to be simple, safe, and at least as effective as other methods in diagnosing myasthenia gravis.

Reprint requests should be addressed to Dr. Genkins, 30 East 60th Street, New York, NY 10022.

Dr. Horowitz is on temporary leave of absence to the Neurophysiology Institute of the University of Copenhagen, Denmark.

Supported in part by grant CA 14827 from the National Cancer Institute, The National Institutes of Health, and a grant from Hoffmann-LaRoche Inc., Nutley, NJ.

This work was presented in part at the annual meeting of the American Academy of Neurology, Miami Beach, May 3, 1975.

Received for publication May 14, 1975.