Telemedicine visits in myasthenia gravis: Expert guidance and the Myasthenia Gravis Core Exam (MG-CE)

Amanda C Guidon; Srikanth Muppidi; Richard J Nowak; Jeffrey T Guptill; Michael K Hehir; Katherine Ruzhansky; Leeann B Burton; David Post; Gary Cutter; Robin Conwit; Nicte I Mejia; Henry J Kaminski; James F Howard Jr

doi:10.1002/mus.27260

Telemedicine visits in myasthenia gravis: Expert guidance and the Myasthenia Gravis Core Exam (MG-CE)

Muscle Nerve. 2021 Sep;64(3):270-276. doi: 10.1002/mus.27260. Epub 2021 Jul 7.

Authors

Affiliations

¹ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Department of Neurology, Stanford University Hospital, Palo Alto, California, USA.
³ Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴ Department of Neurology, Duke University, Durham, North Carolina, USA.
⁵ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
⁶ Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷ Department of Biostatistics, University of Alabama, Birmingham, Alabama, USA.
⁸ Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, NINDS, Rockville, Maryland, USA.
⁹ Department of Neurology, George Washington University Medical Center, Washington, District of Columbia, USA.
¹⁰ Department of Neurology, The University of North Carolina, Chapel Hill, North Carolina, USA.

^# Contributed equally.

Abstract

Introduction/aims: Telemedicine may be particularly well-suited for myasthenia gravis (MG) due to the disorder's need for specialized care, its hallmark fluctuating muscle weakness, and the potential for increased risk of virus exposure among patients with MG during the coronavirus disease 2019 (COVID-19) pandemic during in-person clinical visits. A disease-specific telemedicine physical examination to reflect myasthenic weakness does not currently exist.

Methods: This paper outlines step-by-step guidance on the fundamentals of a telemedicine assessment for MG. The Myasthenia Gravis Core Exam (MG-CE) is introduced as a MG-specific, telemedicine, physical examination, which contains eight components (ptosis, diplopia, facial strength, bulbar strength, dysarthria, single breath count, arm strength, and sit to stand) and takes approximately 10 minutes to complete.

Results: Pre-visit preparation, remote ascertainment of patient-reported outcome scales and visit documentation are also addressed.

Discussion: Additional knowledge gaps in telemedicine specific to MG care are identified for future investigation.

Keywords: COVID-19; myasthenia gravis; outcome measures; physcial examination; telemedicine.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 / prevention & control*
Female
Humans
Male
Myasthenia Gravis / diagnosis*
Myasthenia Gravis / therapy
Patient Education as Topic / methods*
Patient Education as Topic / standards
Physical Examination / methods*
Physical Examination / standards
Physicians* / standards
Telemedicine / methods*
Telemedicine / standards

Abstract

Publication types

MeSH terms

Grants and funding