Table 1.

Studies showing the sensitivity and specificity of individual tests to diagnose myasthenia

Test	Sensitivity (%)	Specificity (%)	References
Ice-pack test
All cases of MG	28–96	31–100	[7, 8, 73, 82]
Ocular MG	85	33	[73]
Generalised MG	90	–	[73]
Ice-pack test and SFEMG	79	64	[73]
Ice-pack test and RNS	24	92	[73]
Antibody tests
Anti-AChR Ab
All cases of MG	50–97	95–100	[16, 28, 65]
Ocular MG	38–75	–	[30, 60, 72]
Generalised MG	73–94	–	[30, 60, 72]
Clustered AChR Ab	13–66	100	[10–13]
Acetylcholinesterase Ab	19–22	–	[29]
Titin receptor Ab	20–74	–	[27, 29]
Ryanodine receptor Ab	15–74	–	[27–29]
Anti-AChR or Anti-MuSK-Ab	73	–	[74]
Anti-MuSK-Ab	27–70b	93–100	[13, 19–22]
Anti-LRP4 Ab	3	–	[13]
All 4 antibodiesa	94	84	[29]
RNS test
All cases of MG	15–92	73–100	[31–33, 35, 38, 42, 43, 46, 56, 72–75]
Ocular MG	14–67	91	[30, 31, 36, 60, 65, 72, 73]
Generalised MG	32–94	–	[30, 31, 36, 60, 65, 72, 73]
SFEMG test
All cases of MG	64–100	22–97	[32, 42, 45, 48–50, 59–61, 65, 73–75, 87]
Ocular MG	73–100	22–100c	[32, 49, 52, 60, 62, 72–74]
Generalised MG	85–99	91–100c	[32, 49, 60, 62, 72–74]
RNS and SFEMG tests	18	91	[73]
Edrophonium test
All cases of MG	50–92	97	[67, 79]
Ocular MG	92	97
Generalised MG	88	97
Neostigmine test
All cases of MG	83	97	[82]
Ocular MG	93	–	[30]
Generalised MG	98	–	[30]
oVEMP test	63–89	64–100	[87]

oVEMP Ocular vestibular-evoked myogenic potentials, MG myasthenia gravis, SFEMG single-fibre electromyography, RNS repetitive nerve stimulation, MuSK muscle-specific kinase, Ab antibody, AChR acetylcholine receptor, LRP4 LDL receptor-related protein 4, RyR ryanodine receptor

^aAll 4 antibodies = Acetylcholine receptor, acetylcholinesterase, titin and ryanodine receptor antibodies

^bIn those who are seronegative for anti-AChR antibody

^cDepending on control population