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We appreciate the comments from Drs Liu and Chan regarding our article describing a case of ocular myasthenia gravis with anti-MuSK antibodies. We are in agreement that a Tensilon test is a useful test in the diagnosis of myasthenia and could have been performed during her evaluation. While the Tensilon test is highly sensitive, it does lack specificity and is associated with a variety of potential adverse events, including symptomatic bradycardia with hypotension.¹ Our patient experienced generalized "shakiness" on low doses of pyridostigmine bromide, providing another reason to avoid administering Tensilon.

Some experts recommend that objective serologic or electrophysiologic evidence of myasthenia gravis be documented prior to the use of long-term immunosuppression or thymectomy so that there can be no question of the diagnosis at a later time when the clinical signs may no longer be evident. While results from a Tensilon test can be dramatic, milder degrees . . . [Full Text of this Article]

AUTHOR INFORMATION

James B. Caress, MD; Christopher H. Hunt, MD

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