Stimulation SFEMG in myasthenia gravis

The diagnostic usefulness of single-fiber electromyography (SFEMG) in the diagnosis of neuromuscular transmission disorders is well established. Increased jitter is one of the earliest indications of abnormality. In patients with severe weakness, tremor, or altered consciousness, performance of the study is difficult because of the degree of cooperation needed. We studied five patients and eight normal subjects with voluntary and stimulation SFEMG techniques. Our results, in search of normal values and changes with pathology, revealed differences in the values of jitter and the percentage of abnormal fibers between both techniques. The mean consecutive difference (MCD) is smaller (on average 30% less), and the percentage of abnormal fibers is lower (on average 10% less) with the stimulation technique. These differences are largely explained by the jitter measurement of one endplate with the stimulation technique versus two endplates with the voluntary. They may also be related, however, to the difference in motor unit populations sampled with each technique.