Sixty cases of ocular myasthenia gravis treated with acupuncture and moxibustion at extra-meridian and collateral

Objective To explore effective therapeutic method for the treatment of ocular myasthenia gravis. Methods Sixty cases of ocular myasthenia gravis were selected. The acupuncture was applied at Dàzhuī （大椎 GV 14）, Bǎihuì （百会 GV 20）, Shàngxīng （上星 GV 23） of Governor Vessel, and its crossing points with Yinqiao and Yangqiao Meridian, such as Jīngmíng （睛明 BL 1）, shēnmài （申脉 BL 62）, Dìcāng （地仓 ST 4）, Jūliáo （巨髎 ST 3）, Chéngqì （承泣 ST 1 ）, etc. Besides, ginger-partition moxibustion was applied at Yángbái （阳白 GB 14） and Sìbái （四白 ST 2）. The plum-blossom needle was applied at upper limb distribution of lung channel of hand taiyin, heart channel of hand shaoyin and pericardium channel of hand jueyin. The patients’ clinical symptoms, potential degradation percentages of repetitive nerve stimulation （RNS） in low frequency were observed. Results 8 cases were clinically cured, 20 cases were basically cured, 12 cases were remarkably effective, 15 cases were effective and 5 cases were failed. The total effective rate was 91.7%. Compared with before the treatment, the potential degradation percentages of repetitive nerve stimulation in low frequency were lowered [（19.44±6.28）% vs （8.78±3.12）%, （P0.05）]. Conclusion Acupuncture and moxibustion at extra-meridian and collateral for ocular myasthenia gravis could achieve positive efficacy.

Single fiber electromyography in the diagnosis of ocular myasthenia gravis:report of 90 cases

Background The aim of this study was to evaluate single fiber electromyography (SFEMG) in the diagnosis of ocular myasthenia gravis (OMG),compared with repetitive nerve stimulation (RNS) and blood concentration of antibody to acetylcholine receptor (AchRAb).Methods SFEMG,RNS and AchRAb titration were measured in 90 patients with OMG (44 men,46 women). Results Markedly increased jitter and ratio of block in the frontalis and the extensor digitorum communis (EDC) were observed (83.3% and 61.1%,respectively). The mean jitter was 43.6±14.5 μs,and the percentages of jitter>55 μs and blocking were 16.9%±19% and 3.5%±9.5% respectively in the EDC. The mean jitter was 64.3±25.6 μs,and the percentages of jitter >55 μs and blocking were 33.5%±27.6% and 29.3%±23.2% respectively in the frontalis. The percentage of abnormal RNS was 27.8% (25/90). There was an increased AchRAb titration in 29 (32.2%) of the 90 patients. Increased jitter,blocking was negatively correlated with maximum decrement to RNS ( P <0.01). 11.4% (4/35) of patients with abnormal RNS and 24.1% (7/29) patients with abnormal AchRAb were seen in the patients with normal SFEMG in the EDC. Conclusion SFEMG test showed the highest sensitivity in the diagnosis of OMG. To our knowledge, the three methods (SFEMG,RNS and AchRAb) are complementary in the diagnosis and differential diagnosis of OMG.

A Computer-Aided System for Ocular Myasthenia Gravis Diagnosis

The current mode of clinical aided diagnosis of Ocular Myasthenia Gravis(OMG)is time-consuming and laborious,and it lacks quantitative standards.An aided diagnostic system for OMG is proposed to solve this problem.The values calculated by the system include three clinical indicators:eyelid distance,sclera distance,and palpebra superior fatigability test time.For the first two indicators,the semantic segmentation method was used to extract the pathological features of the patient's eye image and a semantic segmentation model was constructed.The patient eye image was divided into three regions:iris,sclera,and background.The indicators were calculated based on the position of the pixels in the segmentation mask.For the last indicator,a calculation method based on the Eyelid Aspect Ratio(EAR)is proposed;this method can better reflect the change of eyelid distance over time.The system was evaluated based on the collected patient data.The results show that the segmentation model achieves a mean Intersection-Over-Union(mIoU)value of 86.05%.The paired-sample T-test was used to compare the results obtained by the system and doctors,and the p values were all greater than 0.05.Thus,the system can reduce the cost of clinical diagnosis and has high application value.

Clinical Features and Prognosis of Ocular Myasthenia Gravis Patients with Different Phenotypes

INTRODUCTIONMyasthenia gravis （MG） is an autoimmune neuromuscular disorder caused by anti-acetylcholine receptor antibodies （AChR-Abs） or other etiologies.Ocular symptoms were the first presentations in 40-50％ of MG patients.Ptosis and diplopia were the most common symptoms of ocular MG （OMG）.Limited studies demonstrated that patients presented with initial symptoms of only ptosis in 47％,only diplopia in 14％ and both ptosis and diplopia in 39％ of OMG.[1] Variations of diplopia or ptosis did not significantly affect the physical or mental status of OMG.

Single-fiber Electromyography in the Extensor Digitorum Communis for the Predictive Prognosis of Ocular Myasthenia Gravis： A Retrospective Study of 102 Cases

Background： Single-fiber electromyography （SFEMG） abnormality in the extensor digitorum communis （EDC） was reported in ocular myasthenia gravis （OMG）, which indicated subclinical involvement beyond extraocular muscles in OMG patients. The relationship between the abnormal findings of SFEMG in EDC and the probability for OMG to develop generalized myasthenia gravis （GMG） is unknown, This retrospective study aimed to determine the predictive value of abnormality of SFEMG in EDC of OMG patients. Methods： One-hundred and two OMG patients underwent standard clinical diagnosis process and SFEMG test in EDC muscle when diagnosed and were clinically followed up for 5 years. The SFEMG data were compared between different clinical groups according to thymus status, onset age, and different outcome of OMG developing. Chances of progressing to GMG were compared between two different groups according to SFEMG and repetitive nerve stimulation （RNS） results, acetylcholine receptor antibody （AchRAb） titer, thymus status, and onset age. Results： Abnormal SFEMG results were observed in 84 （82.4%） patients. The mean jitter, percentage of jitter 〉55 Its （%）, and blocking were higher in OMG patients than in healthy volunteers. There were no statistical differences in jitter analysis between thymoma group and non-thymoma group （P = 0.65）, or between the later OMG group and the later GMG group （P = 0.31）, including mean jitter, percentage of jitter 〉55 Its （%）, and blocking. Elderly group （〉45 years old） had a higher mean jitter than younger group （t = 2.235, P = 0.028）. Total 55 OMG developed GMG, including 47 in abnormal SFEMG group while 8 in normal SFEMG group. There was no statistical difference in the conversion rates between the two groups （x^2 = 0.790, P = 0.140）. RNS abnormality, AchRab titer, or onset age had no correlation with OMG prognosis （P = 0.150, 0.070, 0.120, respectively） while thymoma did （x^2 = 0.510, P = 0.020）. Conclusion： SFEMG test in the EDC showed high abnormality in OMG, suggesting subclinical involvement other than extraocular muscles. Nevertheless, the abnormal jitter analysis did not predict the prognosis of OMG according to clinical follow-up.