{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:18:11Z","timestamp":1787314691918,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction\/Aims<\/jats:title>\n                    <jats:p>Stimulated jitter analysis (stim\u2010JA) involves analyzing the variation in time intervals between stimulations and action potentials, expressed as the mean consecutive difference (MCD). The MCD upper limits are derived from adult populations and warrant a re\u2010evaluation in children to accurately diagnose neuromuscular junction (NMJ) defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted which analyzed orbicularis oculi stim\u2010JA studies performed on children between January 2014 and December 2021. The clinical profile, acetylcholine receptor (AChR), and muscle\u2010specific kinase (MuSK) antibody status as well as stim\u2010JA study results were retrieved. Bootstrapping was applied to the stim\u2010JA studies to derive de novo MCD upper limits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010seven stim\u2010JA studies were performed on patients aged 3\u201319\u2009years with either definite myasthenia gravis presentations and NMJ defects (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919, 17 AChR+, 2 MuSK+) or those with normal neurological examinations who were seronegative (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098). Four hundred ninety\u2010nine apparent single fiber action potentials (ASFAPs) were analyzed with the individual and mean MCD significantly higher in children with autoimmune myasthenia (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Bootstrapping analysis revealed that MCD upper limits of 39\u2009\u03bcs for individual MCD and 24\u2009\u03bcs for mean MCD significantly improved specificity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) while maintaining sensitivity of the test in distinguishing definite MG NMJ defect from normal NMJ function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Stim\u2010JA using revised upper limits may help clinicians avoid the over\u2010diagnosis of NMJ disorders in children. Stim\u2010JA is a safe and well\u2010tolerated method to screen for definite MG in children over 2\u2009years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mus.28363","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T05:22:22Z","timestamp":1738214542000},"page":"593-599","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Orbicularis Oculi Stimulated Jitter Analysis in Children With Autoimmune Myasthenia Gravis"],"prefix":"10.1002","volume":"71","author":[{"given":"Vishva","family":"Natarajan","sequence":"first","affiliation":[{"name":"Georgia Institute of Technology  Atlanta Georgia USA"},{"name":"Geisel School of Medicine at Dartmouth  Hanover New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1992-4556","authenticated-orcid":false,"given":"Sumit","family":"Verma","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Neurology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880170207"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27573"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20108749.2008.02038.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25685"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25012"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.10426"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2019.04.005"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.46.4.305"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24657"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26319"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542\u2010196305000\u201000004"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100028\u20101091752"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000161"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25606"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24750"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2010.07.012"},{"key":"e_1_2_11_18_1","volume-title":"Python 3 Reference Manual","author":"Van Rossum G.","year":"2009"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1176344552"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.4135\/9781412983532"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0005\u20102795(75)90109\u20109"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12864\u2010019\u20106413\u20107"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2016.11.020"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.28363","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T17:55:00Z","timestamp":1741715700000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.28363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,30]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/mus.28363"],"URL":"https:\/\/doi.org\/10.1002\/mus.28363","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,30]]},"assertion":[{"value":"2024-04-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}