Dr Narayanaswami is a neuromuscular neurologist and Associate Professor of Neurology at Harvard Medical School, Vice-Chair of Clinical Operations and Director of Quality Improvement and Patient Safety, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA. She serves on the Medical and Scientific Advisory Board of the Myasthenia Gravis Foundation of America In her clinical practice she manages neuromuscular conditions, with special emphasis on myasthenia gravis, myopathies and muscular dystrophies. Her broad area of research is in health services and includes dissemination and implementation research and comparative effectiveness research. Her major clinical research interest is myasthenia gravis. Her advocacy work seeks to incorporate health services research with healthcare policy to improve patient care.

The electrophysiologic testing of myasthenia gravis includes demonstration of decremental response on repetitive nerve stimulation and increased jitter and blocking on single fibre electromyography. Repetitive nerve stimulation is a technique where the physiology of neuromuscular junction transmission is directly translated into electrophysiologic measurements in patients. The physiologic underpinnings of the abnormalities in neuromuscular junction transmission on repetitive nerve stimulation will be discussed, after a brief description of salient epidemiologic and clinical features of the disorder. The diagnostic accuracy and utility of electrophysiologic testing will be examined, followed by a review of the new antibodies associated with myasthenia gravis. Finally, a brief outline of the novel mechanisms of action of new therapeutic agents will be outlined.