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The use of medicinal products is permitted only upon a doctor’s prescription. Consultations are provided by clinic specialists in person or online in accordance with applicable law.
CHECKUP OF MYASTHENIA
Comprehensive Check-up "Myasthenia" enables the detection of autoimmune mechanisms of the disease, assessment of comorbid disorders, and differential diagnosis with other neuromuscular diseases. An expanded testing profile and neurologist consultation ensure the most accurate diagnosis and help initiate timely treatment.
1. Laboratory Diagnostics (Specific Antibodies)
This is the key step to confirm the diagnosis and determine the form of myasthenia.
- Antibodies to Acetylcholine Receptors (AChR Abs):
Purpose: The main marker, found in 80–85% of patients with the generalized form and 50% with the ocular form.
- Antibodies to Muscle-specific Tyrosine Kinase (MuSK Abs):
Purpose: Tested if AChR test is negative (seronegative myasthenia). Present in 40% of AChR-negative patients, often associated with more severe course and involvement of bulbar muscles.
- Antibodies to Lipoprotein-related Protein 4 (LRP4):
Purpose: An additional marker for double seronegative patients (when both AChR and MuSK are negative).
- Antibodies to Titin (Anti-titin) and Ryanodine Receptors (RyR):
Purpose: Markers of severe disease and strong predictors of thymoma presence (tumor of the thymus), especially in patients under 60 years old.
2. Instrumental and Functional Diagnostics
- Electroneuromyography (ENMG) with Decrement Test (Rhythmic Stimulation):
Purpose: To assess the reliability of neuromuscular transmission. A specific drop (decrement) in M-response amplitude of more than 10% during repeated low-frequency stimulation (2–3 Hz) is sought.
- Single-Fiber Electromyography (SFEMG):
Purpose: The most sensitive method (up to 95–99%). Measures "jitter" (variability in impulse transmission timing). Used if standard ENMG is normal but clinical symptoms persist.
- CT or MRI of the Anterior Mediastinal Organs (with contrast):
Purpose: Mandatory screening for thymic hyperplasia or thymoma. Thymus pathology is directly related to the autoimmune process in myasthenia.
3. General Clinical and Autoimmune Profile (Differential Diagnosis)
Myasthenia is often associated with other autoimmune diseases, and some somatic disorders may exacerbate weakness.
- Thyroid Panel: TSH, Free T3, Free T4, antibodies to thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG). Thyroid disorders (Hashimoto's, Graves' disease) are comorbid with myasthenia.
- Complete Blood Count + ESR, C-Reactive Protein (CRP): To exclude hidden inflammatory processes.
- Blood Electrolytes: Potassium (K⁺), Calcium (Ca²⁺), Magnesium (Mg²⁺), Sodium (Na⁺). Electrolyte imbalances may mimic or worsen muscle weakness.
4. Respiratory Function Assessment (Critical in Generalized Cases)
- Spirometry (Pulmonary Function Test - PFT):
Purpose: To evaluate lung vital capacity (VC) and forced vital capacity (FVC). Conducted to monitor the risk of myasthenic crisis and respiratory muscle involvement.
1. Laboratory Diagnostics (Specific Antibodies)
This is the key step to confirm the diagnosis and determine the form of myasthenia.
- Antibodies to Acetylcholine Receptors (AChR Abs):
Purpose: The main marker, found in 80–85% of patients with the generalized form and 50% with the ocular form.
- Antibodies to Muscle-specific Tyrosine Kinase (MuSK Abs):
Purpose: Tested if AChR test is negative (seronegative myasthenia). Present in 40% of AChR-negative patients, often associated with more severe course and involvement of bulbar muscles.
- Antibodies to Lipoprotein-related Protein 4 (LRP4):
Purpose: An additional marker for double seronegative patients (when both AChR and MuSK are negative).
- Antibodies to Titin (Anti-titin) and Ryanodine Receptors (RyR):
Purpose: Markers of severe disease and strong predictors of thymoma presence (tumor of the thymus), especially in patients under 60 years old.
2. Instrumental and Functional Diagnostics
- Electroneuromyography (ENMG) with Decrement Test (Rhythmic Stimulation):
Purpose: To assess the reliability of neuromuscular transmission. A specific drop (decrement) in M-response amplitude of more than 10% during repeated low-frequency stimulation (2–3 Hz) is sought.
- Single-Fiber Electromyography (SFEMG):
Purpose: The most sensitive method (up to 95–99%). Measures "jitter" (variability in impulse transmission timing). Used if standard ENMG is normal but clinical symptoms persist.
- CT or MRI of the Anterior Mediastinal Organs (with contrast):
Purpose: Mandatory screening for thymic hyperplasia or thymoma. Thymus pathology is directly related to the autoimmune process in myasthenia.
3. General Clinical and Autoimmune Profile (Differential Diagnosis)
Myasthenia is often associated with other autoimmune diseases, and some somatic disorders may exacerbate weakness.
- Thyroid Panel: TSH, Free T3, Free T4, antibodies to thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG). Thyroid disorders (Hashimoto's, Graves' disease) are comorbid with myasthenia.
- Complete Blood Count + ESR, C-Reactive Protein (CRP): To exclude hidden inflammatory processes.
- Blood Electrolytes: Potassium (K⁺), Calcium (Ca²⁺), Magnesium (Mg²⁺), Sodium (Na⁺). Electrolyte imbalances may mimic or worsen muscle weakness.
4. Respiratory Function Assessment (Critical in Generalized Cases)
- Spirometry (Pulmonary Function Test - PFT):
Purpose: To evaluate lung vital capacity (VC) and forced vital capacity (FVC). Conducted to monitor the risk of myasthenic crisis and respiratory muscle involvement.
1000у.е.
WHAT IS INCLUDED IN THIS CHECK-UP:
Laboratory tests
Specific laboratory profile:
- IgG antibodies to acetylcholine receptors (AChR).
- Antibodies to muscle-specific tyrosine kinase (MuSK).
- Antibodies to LRP4 protein (lipoprotein-related receptor protein 4) (Rödger laboratory, Germany).
- Antibodies to titin (connectin) (Rödger laboratory, Germany).
- Antibodies to ryanodine receptor (RyR1-Ab) (Rödger laboratory, Germany).
- Ganglioside profile, IgG/IgM antibodies (GM1, GM2, GM3, GM4, GD1a, GD1b, GD2, GD3, GT1a, GT1b, GQ1b), immunoblot.
- Creatine kinase-MM (CK-MM).
- Lactate dehydrogenase (LDH).
General tests and accompanying markers:
- Thyroid hormones and antibodies:
- TSH;
- Free T4;
- Free T3;
- Antibodies to thyroglobulin (Anti-TG);
- Antibodies to thyroid peroxidase (Anti-TPO).
- Electrolytes (sodium, potassium, chloride, calcium) and magnesium.
- Complete blood count.
- C-reactive protein (CRP).
- Vitamin B12 (cyanocobalamin).
- Serum iron.
- Ferritin.
Neurologist consultation.
Medical support by a coordinator at all stages of examination.
--------------------------------------
Preparation for this check-up in myasthenia does not require special complex preparation; however, following some rules will help obtain the most accurate results.
Preparation for the examination:
- Blood is drawn in the morning on an empty stomach (after 8–12 hours of fasting). Only still water is allowed.
- Avoid alcohol 24 hours before the examination.
- Avoid intense physical activity, sports, and sauna 24 hours before the test.
- Do not smoke or consume coffee, strong tea, or energy drinks 1–2 hours before blood collection.
- It is recommended to be in a calm state for 15–20 minutes before the test in the morning.
Medication intake
Do not stop taking any prescribed medications on your own.
If you are taking medications for myasthenia treatment (pyridostigmine, kalimin, proserin), immunosuppressants, hormonal medications, or other drugs, be sure to inform your doctor and laboratory staff.
If temporary discontinuation of any medication before specific tests is required, this should be determined only by your treating physician.
Additional recommendations:
It is preferable to perform tests before infusion therapy, intravenous injections, and physiotherapy procedures.
If a neurologist consultation is planned simultaneously, bring all available medical documents: previous test results, electromyography (EMG) results, CT, MRI scans, hospital discharge summaries, and a list of current medications.
This approach will enable the doctor to most accurately assess disease activity, confirm or exclude the autoimmune nature of myasthenia, and select the optimal treatment strategy.
Laboratory tests
Specific laboratory profile:
- IgG antibodies to acetylcholine receptors (AChR).
- Antibodies to muscle-specific tyrosine kinase (MuSK).
- Antibodies to LRP4 protein (lipoprotein-related receptor protein 4) (Rödger laboratory, Germany).
- Antibodies to titin (connectin) (Rödger laboratory, Germany).
- Antibodies to ryanodine receptor (RyR1-Ab) (Rödger laboratory, Germany).
- Ganglioside profile, IgG/IgM antibodies (GM1, GM2, GM3, GM4, GD1a, GD1b, GD2, GD3, GT1a, GT1b, GQ1b), immunoblot.
- Creatine kinase-MM (CK-MM).
- Lactate dehydrogenase (LDH).
General tests and accompanying markers:
- Thyroid hormones and antibodies:
- TSH;
- Free T4;
- Free T3;
- Antibodies to thyroglobulin (Anti-TG);
- Antibodies to thyroid peroxidase (Anti-TPO).
- Electrolytes (sodium, potassium, chloride, calcium) and magnesium.
- Complete blood count.
- C-reactive protein (CRP).
- Vitamin B12 (cyanocobalamin).
- Serum iron.
- Ferritin.
Neurologist consultation.
Medical support by a coordinator at all stages of examination.
--------------------------------------
Preparation for this check-up in myasthenia does not require special complex preparation; however, following some rules will help obtain the most accurate results.
Preparation for the examination:
- Blood is drawn in the morning on an empty stomach (after 8–12 hours of fasting). Only still water is allowed.
- Avoid alcohol 24 hours before the examination.
- Avoid intense physical activity, sports, and sauna 24 hours before the test.
- Do not smoke or consume coffee, strong tea, or energy drinks 1–2 hours before blood collection.
- It is recommended to be in a calm state for 15–20 minutes before the test in the morning.
Medication intake
Do not stop taking any prescribed medications on your own.
If you are taking medications for myasthenia treatment (pyridostigmine, kalimin, proserin), immunosuppressants, hormonal medications, or other drugs, be sure to inform your doctor and laboratory staff.
If temporary discontinuation of any medication before specific tests is required, this should be determined only by your treating physician.
Additional recommendations:
It is preferable to perform tests before infusion therapy, intravenous injections, and physiotherapy procedures.
If a neurologist consultation is planned simultaneously, bring all available medical documents: previous test results, electromyography (EMG) results, CT, MRI scans, hospital discharge summaries, and a list of current medications.
This approach will enable the doctor to most accurately assess disease activity, confirm or exclude the autoimmune nature of myasthenia, and select the optimal treatment strategy.
