Repetitive nerve stimulation often fails to detect abnormal decrement in acute severe generalized Myasthenia Gravis

Neuromuscular transmission failure is routinely evaluated in the clinic through repetitive nerve stimulation (RNS) test and single fiber electromyography (SFEMG) or concentric needle electrode jitter analysis (CNE) (Stalberg and Sanders, 2009). The RNS test is often regarded as the fastest non-invasive first line examination method in the diagnostic evaluation of MG (Medicine, 2001a). The successive reduction of amplitude of the compound motor action potential (CMAP) upon 10 supramaximal stimuli in RNS is considered to reflect the safety factor for neuromuscular transmission (Mills, 2005).

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