J Korean Ophthalmol Soc.  2017 Jan;58(1):74-78. 10.3341/jkos.2017.58.1.74.

Intravenous Neostigmine Test for Diagnosis of Ocular Myasthenia Gravis

• Kim DI
• Lee BJ
• Kim SJ

• KMID: 2367845
• DOI: http://doi.org/10.3341/jkos.2017.58.1.74

Abstract

PURPOSE
In the present study, we evaluated the validity of intravenous neostigmine administration combined with alternate prism cover test (APCT) measurement as a confirmatory diagnostic method for confusing cases of myasthenia gravis with ocular involvement.
METHODS
Neostigmine was administered intravenously in 26 suspicious myasthenic diplopia patients under electrocardiographic monitoring. Distance deviation at primary position was evaluated with APCT at 5, 10, 15, 20, and 30 minutes after intravenous injection of neostigmine. Margin reflex distance was also evaluated at each time point.
RESULTS
Seven of 26 patients were diagnosed as myasthenic diplopia based on a positive neostigmine test. Among these patients, 6 had strabismus at the primary position and 5 patients had ptosis. In patients who showed positive results, all 6 patients showed improvement of strabismus. However, ptosis was not improved in 1 patient. The improvement of strabismus and ptosis reached a peak at 10 to 15 minutes after neostigmine administration.
CONCLUSIONS
Intravenous neostigmine administration combined with APCT is a rapid, objective and safe method in hard-to-diagnose cases of myasthenia gravis with ocular involvement. When performing the neostigmine test for myasthenia gravis with ocular involvement, not only the lid position but also strabismus should be evaluated quantitatively to avoid a false negative results.

Keyword

Neostigmine; Ocular myasthenia gravis; Ptosis; Strabismus

MeSH Terms

Diagnosis*
Diplopia
Electrocardiography
Humans
Injections, Intravenous
Methods
Myasthenia Gravis*
Neostigmine*
Reflex
Strabismus
Neostigmine

Figure

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  Figure 1. Degree of strabismus after neostigmine injection. Six patients showed positive results. The improvement of stra-bismus reached a peak at 11.7 minutes after neostigmine administration. PD = prism diopter.

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  Figure 2. Degree of ptosis after neostigmine injection in the right eye. Four patients showed positive results. The improve-ment of ptosis reached a peak at 11.3 minutes after neo-stigmine administration. MRD = margin reflex distance.

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  Figure 3. Degree of ptosis after neostigmine injection in the left eye. Four patients showed positive results. The improve-ment of ptosis reached a peak at 11.3 minutes after neo-stigmine administration. MRD = margin reflex distance.

Reference

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