The Use of the Ice Pack Test in Myasthenia Gravis

Kearsey, Christopher; Fernando, P.; D'Costa, D F; Ferdinand, Phillip

doi:10.1258/shorts.2009.090037

Cited by 25 publications

(20 citation statements)

References 7 publications

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“…Ptosis can be unilateral or bilateral, symmetrical or asymmetrical, and, like double vision, can increase in bright sunlight, heat, or strenuous work, and can be relieved by wearing sunglasses or shutting the eyes temporarily. Heat increases the symptoms, whereas cold leads to improvement [7].…”

Section: Case History and Clinical Symptoms Of Pomgmentioning

confidence: 99%

Pure Ocular Myasthenia gravis

Kirzinger

Schötz

Schalke

2018

Neurology International Open

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Pure ocular myasthenia was always described as a separate entity in historical publications. More than 50% of patients develop generalized symptoms in the course of the disease. Therefore pure ocular symptoms can be the beginning of generalized myasthenia, nevertheless there is a small group of patients who suffer lifelong purely ocular symptoms. The basis, therefore, seems to be special immunological, biochemical and pathophysiological mechanisms leading to specific local changes of the neuromuscular junction. The diagnostic procedure is hampered as antibodies against acethylcholine receptors and MuSK can be demonstrated in less than 50% of these patients. Therapy of pure ocular myasthenia does not differ fundamentally from other subgroups of myasthenia gravis and is implemented with cholinesterase inhibitors, steroids and common immunosuppressants. Thymomectomy is not recommended in general, but randomized controlled studies are lacking.

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Section: Case History and Clinical Symptoms Of Pomgmentioning

confidence: 99%

Pure Ocular Myasthenia gravis

Kirzinger

Schötz

Schalke

2018

Neurology International Open

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“…Sie kann durch Tragen einer Sonnenbrille oder vorübergehendes Schließen der Augen abgemildert werden. Wärme verstärkt die Symptomatik und Kälte führt zur Besserung [7].…”

Section: Anamnese Und Klinische Symptomatik Der Pomgunclassified

Die okuläre Myasthenia gravis

2018

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ZusammenfassungIn historischen Publikationen wurde die okuläre Myasthenie (MG) stets als eigenständige Entität beschrieben. Allerdings entwickeln weit über 50 % der Patienten im Verlauf eine generalisierte Myasthenie. Ausschließlich okuläre Symptome können bei allen erworbenen Myasthenien die Initialsymptomatik darstellen, trotzdem scheint es eine kleine Gruppe von Patienten zu geben, bei denen lebenslang nur eine rein okuläre Symptomatik auftritt. Spezielle Mechanismen der Immunologie, Biochemie und Pathophysiologie führen lokal zu sehr spezifischen Veränderungen an der neuromuskulären Synapse, die in einer rein okulären Myasthenie resultieren. Die Diagnostik ist dabei erschwert, da nur bei weniger als 50 % der Patienten Antikörper gegen den Acetylcholin Rezeptor oder MuSK nachweisbar sind. Dies erfordert stets eine sorgfältige Differenzialdiagnostik, um andere, isoliert okuläre Symptome verursachende Krankheitsentitäten nachzuweisen bzw. auszuschließen. Die Therapie der okulären Myasthenie unterscheidet sich nicht grundlegend von den anderen Subgruppen der Myasthenie. In der symptomatischen Behandlung wird sie mit Cholinesterasehemmern durchgeführt, die kausale Behandlung erfolgt immunsuppressiv mit Corticosteroiden und anderen üblicherweise eingesetzten Immunsuppressiva (Azathioprin, MMF etc.). Die Thymektomie wird im Allgemeinen bei der primär rein okulären Myasthenie nicht empfohlen. Kontrollierte, randomisierte Studien hierzu gibt es bisher jedoch nicht.

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“…The basis of this test is the fact that AChE is inhibited at lower temperature. The test is considered positive if there is a ≥2mm raise in the eyelid after the ice is removed [31]. On electrophysiological examination, most patients exhibit decremental electromyographic response on repetitive supramaximal stimulation of the motor nerves and increased jitter and neuromuscular blocking in single fiber electromyography [EMG].…”

Section: General Background Aboutmentioning

confidence: 99%

Sleep Related Conditions with Myasthenia Gravis: Evidence, Causes and Implications

Hamed¹

2016

SJPH

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Myasthenia gravis (MG) is an autoimmune disease caused mainly by antibodies against skeletal muscle nicotinic acetylcholine receptors (nAChRs) at the postsynaptic membrane resulting in depletion of acetylcholine at the neuromuscular junction (NMJ). Muscle fatigue is the cardinal symptom of MG. Respiratory muscle weakness and breathing problems are manifestations of MG even in mild stages of the disease resulting in significant morbidity and mortality. Also sleep related conditions are among the manifestations of MG which include sleep disordered breathing (SDB) [i.e. central (CSA) and obstructive (OSA) sleep apneas, hypoventilation or hypoxemic syndromes], reduced sleep efficiency and quality, increased number of nocturnal awakenings, excessive daytime sleepiness, reduced rapid eye movement sleep and altered sleep perception and dreaming. On the other hand, sleep abnormalities may result in lack of concentration, cognitive impairments and mood disturbances as depression and anxiety. Central and peripheral mechanisms have been suggested for the association between MG and central nervous system manifestations and sleep abnormalities. Neurologists and sleep medicine professionals should be aware of the associations between OSA/CSA, hypoventilation and other sleep related conditions with MG and consider systematic investigations including polysomnography and ventilatory support. This will reduce morbidity and mortality and improve quality of lives of patients with MG.

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The Use of the Ice Pack Test in Myasthenia Gravis

Cited by 25 publications

References 7 publications

Pure Ocular Myasthenia gravis

Pure Ocular Myasthenia gravis

Die okuläre Myasthenia gravis

Sleep Related Conditions with Myasthenia Gravis: Evidence, Causes and Implications

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