Abstract Details

Title High-Resolution Manometry is Useful for Diagnosing Myasthenia Gravis with Mild Dysphagia

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 036

Objective To evaluate the efficiency of swallowing pressure assessment using high-resolution manometry (HRM) for the diagnosis of myasthenia gravis.

Background Despite the clinical impact of dysphagia in MG, a standard protocol for reliably diagnosing dysphagia is not yet established. HRM with 36 circumferential pressure sensors spaced 1 cm apart provides precise pharyngeal pressure information. We hypothesized that swallowing pressure assessment using HRM during the edrophonium chloride (EC) test could identify mild bulbar symptoms with no abnormalities on videoendoscopic examination of swallowing (VE) and videofluorographic examination of swallowing (VF).

Design/Methods An ocular MG patient (72-year-old woman) with slight pharyngeal discomfort for 3 months was included. VE and VF revealed no abnormalities. The swallowing pressure along the pharynx and upper esophageal sphincter (UES) was measured using HRM during EC test. Evaluation of HRM parameters including velopharyngeal contractile integral (VPCI), meso-hypopharyngeal contractile integral (MHPCI), UES relaxation duration, and UES nadir pressure was performed. These parameters were assessed for three swallows with 3 mL water.

Results After EC injection, the VPCI was higher (78.0 ± 5.4 vs 130.6 ± 1.5 mmHg·cm·s) and the MHPCI was higher (134.7 ± 1.3 vs 284.2 ± 11.9 mmHg·cm·s) than these parameters before EC injection. UES relaxation duration and UES nadir pressure were not changed during EC test.

Conclusions Intravenous EC injection improved decreased pharyngeal contractility due to MG. Swallowing pressure assessment with HRM during EC test may be helpful in diagnosing mild bulbar symptoms in MG patients. Further study with more patients is needed.

Authors/Disclosures
Kenjiro Kunieda (Gifu university) PRESENTER	Kenjiro Kunieda has nothing to disclose.
Yuichi Hayashi (Department of Neurology, Gifu University Grad)	Yuichi Hayashi has nothing to disclose.
Nobuaki Yoshikura, MD, PhD (Gifu univesity graduate school of medicine department of neurology)	Dr. Yoshikura has nothing to disclose.
Akio Kimura, MD (Gifu University Graduate School of Medicine)	Dr. Kimura has nothing to disclose.
	No disclosure on file
Takayoshi Shimohata, MD, FAAN (Department of Neurology, Gifu University)	Dr. Shimohata has nothing to disclose.

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