Timely and accurate diagnosis of myasthenia gravis, particularly in patients with fluctuating, isolated ocular involvement, remains challenging. Serological antibody testing and repetitive nerve stimulation of peripheral muscles usually have low sensitivity in these patients. Edrophonium testing may cause adverse events, single-fiber electromyography (SFEMG) is time-consuming and both tests are often unavailable outside specialized institutions. Repetitive ocular vestibular evoked myogenic potential (roVEMP) stimulation has recently been introduced to facilitate the diagnosis of myasthenia gravis. Similar to repetitive nerve stimulation, roVEMPs detect muscle decrements with the benefit of being non-invasive and allowing for direct measurement of the extraocular muscles. This review summarizes the clinical evidence of the diagnostic value of roVEMP for myasthenia. Prospective clinical trials have demonstrated high sensitivity and specificity. RoVEMPs are of particular interest in challenging myasthenia subgroups with isolated ocular involvement, negative serology, and/or negative conventional electrophysiological results. Optimal roVEMP repetition rates of 20-30 Hz have been identified. This promising novel diagnostic tool merits further attention and investigation to establish its value as a clinical test for myasthenia.

中文翻译：

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重复性眼前庭诱发的肌源性电位诊断重症肌无力。

及时准确地诊断重症肌无力，尤其是对于波动，孤立眼球受累的患者，仍然具有挑战性。在这些患者中，血清抗体检测和周围肌肉重复性神经刺激通常敏感性较低。drop测试可能会导致不良事件，单纤维肌电图（SFEMG）很耗时，而且在专门机构之外通常无法进行这两种测试。最近已引入重复性眼前庭诱发肌原性电位（roVEMP）刺激，以促进重症肌无力的诊断。与重复性神经刺激类似，roVEMP可检测肌肉的减少，具有无创性的优点，并且可以直接测量眼外肌。这篇综述总结了roVEMP对肌无力的诊断价值的临床证据。前瞻性临床试验显示出高敏感性和特异性。RoVEMP对于挑战性肌无力亚组特别感兴趣，这些亚组的眼部受累，血清学阴性和/或常规电生理结果阴性。已经确定了20-30 Hz的最佳roVEMP重复率。这种有前途的新型诊断工具值得进一步关注和研究，以确立其作为重症肌无力临床测试的价值。已经确定了20-30 Hz的最佳roVEMP重复率。这种有前途的新型诊断工具值得进一步关注和研究，以确立其作为重症肌无力临床测试的价值。已经确定了20-30 Hz的最佳roVEMP重复率。这种有前途的新型诊断工具值得进一步关注和研究，以确立其作为重症肌无力临床测试的价值。