1.The Response to Low Rate Stimulation of Repetitive Nerve Stimulation Test after Intravenous Tensilon Injection on Patients With Myasthenia Gravis.
Seon Chool HWANG ; Kyu Hyun PARK ; Geo Hyoung KIM ; Mun Seung CHOI ; Dae Su JUNG ; Sang Wook KIM
Journal of the Korean Neurological Association 1992;10(4):413-419
Repetitive nerve stimulation test(RNS) was performed on 32 patients with myasthenia gravis who showed positive response to the tensilon test. The result of the repetitive stimulation test before and after the tensilon injection was compared with the point of improvement of the CMAP and decremental response. The results were as follows: 1. All patients with myasthenis gravis showed decremental responses to the low rate of stimulation in RNS. 2. The results after tensilon injections showed significant improvements of the CMAP in ocularis oculi(OOC), flexor carpi ulnaris(FCU)(P <0.0005), deltoid and abductor digiti quinti muscles(ADQ)(P < 0.005). 3. There were improvements of decremental responses after tensilon injection. 1) At 2/sec, there were significant improvements in the muscles of ADQ(P <0.005), deltoidl OOC and FCU(P < 0.0005). 2) At 3/sec, there were significant improvements in the muscles of OOC(P <0.005), deltoid, FCU and ADQ(P < 0.0005). 3) At 5/sec, there were also significant improvements in all the muscles of OOC, deltoid, ADQ, FCU(P <0.0005). These results showed that tensilon improves the RNS abnorrnalities in myasthenic patients with positive tensilon test. We think these findings before and after the tensilon injection are helpful to diagnose and differentiate a patient with suspected myasthenia gravis who has a negative tensilon test or insignificant RNS findings.
Edrophonium*
;
Humans
;
Muscles
;
Myasthenia Gravis*
2.The Response to Low Rate Stimulation of Repetitive Nerve Stimulation Test after Intravenous Tensilon Injection on Patients With Myasthenia Gravis.
Seon Chool HWANG ; Kyu Hyun PARK ; Geo Hyoung KIM ; Mun Seung CHOI ; Dae Su JUNG ; Sang Wook KIM
Journal of the Korean Neurological Association 1992;10(4):413-419
Repetitive nerve stimulation test(RNS) was performed on 32 patients with myasthenia gravis who showed positive response to the tensilon test. The result of the repetitive stimulation test before and after the tensilon injection was compared with the point of improvement of the CMAP and decremental response. The results were as follows: 1. All patients with myasthenis gravis showed decremental responses to the low rate of stimulation in RNS. 2. The results after tensilon injections showed significant improvements of the CMAP in ocularis oculi(OOC), flexor carpi ulnaris(FCU)(P <0.0005), deltoid and abductor digiti quinti muscles(ADQ)(P < 0.005). 3. There were improvements of decremental responses after tensilon injection. 1) At 2/sec, there were significant improvements in the muscles of ADQ(P <0.005), deltoidl OOC and FCU(P < 0.0005). 2) At 3/sec, there were significant improvements in the muscles of OOC(P <0.005), deltoid, FCU and ADQ(P < 0.0005). 3) At 5/sec, there were also significant improvements in all the muscles of OOC, deltoid, ADQ, FCU(P <0.0005). These results showed that tensilon improves the RNS abnorrnalities in myasthenic patients with positive tensilon test. We think these findings before and after the tensilon injection are helpful to diagnose and differentiate a patient with suspected myasthenia gravis who has a negative tensilon test or insignificant RNS findings.
Edrophonium*
;
Humans
;
Muscles
;
Myasthenia Gravis*
3.Laboratory Tests and Their Significances in Myasthenia Gravis.
Dae Won SEO ; In Soo JOO ; Kwang Woo LEE
Journal of the Korean Neurological Association 1994;12(4):694-701
Sometimes it is not easy to make the diagnosis of myasthenia gravis (MG). The aim of our study was to understand the diagnostic sensitivities of tensilon, repetitive nerve stimulation (RNS), single fiber EMG (SFEMG) tests, acetylcholine receptor (AChR) antibodies (Ab), and to know their comparative significances for making diagnosis of MG. Those tests were safely completed in 40 myasthenia gravis, which consisted of 17 ocular, 21 generalized, 1 acute severe, 1 late severe MG. In all 40 subjects at least one of the tests was abnormal. The positive rates of tensilon, RNS tests, SFEMG, AChR Ab were 92.5%, 65.0%, 90.0%, and 82.5% respectively. The sensitivities of each tests were high in severe MG group, compared with those in mild MG group, because the positive rates were decreased from 100.0% to 89.2% in tensilon tests, from 83.3% to 57.1% in RNS test, from 100.0% to 89.2% in SFEMG tests and 91.7% to 78.6% in AChR Ab test. The positive results of RNS test was increased from 32.5% on abductor digiti quinti (ADQ) to 65.0% on orbicularis oculi (OOC). Among 3 cases with negative tensilon test, the RNS test in 1 case, the SFEMG tests were positive in all 3 cases, and the AChR Ab assay 1case. Among 3 cases with negative SFEMG, the tensilon tests were positive in 3 all cases, the RNS test in 1case and the AChR Ab assay in 1 cases. Among 5 cases, with negative RNS teses and negative AChR Ab assay, the tensilon tesrs wre positive in 3 cases and the SFEMG tests in 3 cases. Therefore we conclude that tensilon and SFEMG tests were more sensitive than RNS tests and AChR Ab assay. SFEMG test would be indicated to diagnose MG, especially in those mild MG cases with negative stensilon test. Also AChR Ab assay could improve diagnostic yields.
Acetylcholine
;
Antibodies
;
Diagnosis
;
Edrophonium
;
Myasthenia Gravis*
4.Comparison of Usefulness of Laboratory Tests in Diagnosis of Myasthenia Gravis.
Seung Kwon PARK ; Hyun Cheol DO ; Min Jung KIM ; Seung Yeop LEE ; Mee Yeoung PARK ; Jung Sang HAH ; Wook Nyeun KIM ; Jun LEE
Yeungnam University Journal of Medicine 1998;15(1):125-134
PURPOSE: This study was undertaken to evaluate the clinical usefulness of Tensilon test, repetitive nerve stimulation test(RNST), single fiber EMG(SFEMG) test and acetylcholine receptor antibody(AchR Ab) assay for making diagnosis of myasthenia gravis(MG). METHOD: These tests were performed in 21 MG patients which were classified into 11 ocular, 5 mild generalized, 4 moderate generalized, and 1 chronic severe MG. RESULT: The overall positivity of Tensilon test, SFEMG and AchR Ab was 95%, 87%, and 76% respectively. The overall positivity of RNST was 67%; 38% on flexor carpi ulnaris, 43% on adductor digiti quinti and 62% on orbicularis oculi muscles. The positivity of each test was higher in generalized MG group than in ocular MG group. But we could observe the statistically significant difference only in the RNST(p<0.05). CONCLUSION: Tensilon test showed the highest positivity in all MG groups. So we would like to recommend the Tensilon test for the diagnosis of MG at first, followed by RNST and AchR Ab assay, and SFEMG would be indicated to MG group which showed relatively low postivity in other tests.
Acetylcholine
;
Diagnosis*
;
Edrophonium
;
Humans
;
Muscles
;
Myasthenia Gravis*
5.Tensilon Tonometry in Diagnosis of Myasthenia Gravis.
Dong Jin SHIN ; Hong Ki SONG ; Ju Han KIM ; Kyung Cheon CHUNG ; Myoung Ho KIM ; Ill Won PARK ; Joon Kiu CHOE
Journal of the Korean Neurological Association 1988;6(2):186-190
There are many reports which show that contraction of the extraocular muscles results in an increase in intraocular pressure(IOP). Goldmann tonometer was used to record IOP after Tensilon injection in 22 patients, 10 myasthenics and 12 patients with other neurologic disease. There was a significant difference in IOP measured at 30 seconds after injection between two groups; 1-7(mean: 3.4) mmHg increase in myasthenics but no change, or 1-6 (mean: 1.7) mmHg decrease in patients with other neurologic disease. It is concluded that Tensilon tonometry is a valuable, sensitive and objective method in the diagnosis of myasthenia gravis.
Diagnosis*
;
Edrophonium*
;
Humans
;
Manometry*
;
Muscles
;
Myasthenia Gravis*
6.Findings of repetitive nerve stimulation test in myasthenia gravis: A case-control study.
Dae Seung KIM ; Sang Ho KIM ; Sang Ik LEE ; Chang Won SONG ; Kyu Hyun PARK ; Sang Wook KIM
Journal of the Korean Neurological Association 1991;9(1):57-65
Authors had perforrned repetitive nerve stimulation tests on orbicularis oculi, flexor carpi ulnaris, and abductor digiti quinti muscles in 21 myasthenic patients and 40 normal controls using conventional Oh's rnethod and analysed statistically in detail. The results were as follows: 1) There were no significant statistical differences in CMAP and postexercise potentiation between normal controls and myastheic patients, but there were statistically significant decremental responses in both low-and high-rate of stimulation in myasthenic patients, with characteristic posttetanic potentiation and posttetanic exhaustion. 2) There were no statistical differences among Desmedt's, Stalberg's, and Oh's methods in determining the decremental ratio in low-rate of stimulation. 3) The proximal muscles showed more prominent decremental responses than distal muscles in myasthenic patients, and in three myasthenic patients, (14.3%) there were no statistically significant decremental responses in all tested muscles in spite of postivie edrophonium responses. 4) The gerleralized type myasthenic patients showed more prominent decremental responses than oclular type myasthenic patients. 5) Among the myasthenic patients, the oclular type myasthenic patients showed no statistically significant decremental response in both low-and high-rate of stimulation performed on flexor carpi ulnaris and abductor digiti quinti muscles.
Case-Control Studies*
;
Edrophonium
;
Humans
;
Muscles
;
Myasthenia Gravis*
7.Persistent Diplopia after Local Anesthesia.
Jeong Min HWANG ; Jeong Hun KIM ; Soo Kyung HAN
Journal of the Korean Ophthalmological Society 2002;43(10):1982-1987
PURPOSE: To determine causative factors of persistent diplopia after local anesthesia for ophthalmic surgery. METHODS: Prism and alternate cover test in the diagnostic positions of gaze and ductions/versions testing were performed in 26 patients with persistent diplopia six months after local anesthesia. Lancaster test, Bielshowsky head tilt test, double Maddox rod test, funduscopic examination for torsion, forced duction test, force generation test, tensilon test, thyroid function test, and/or orbit CT were done when necessary. RESULTS: Most of the patients (24 patients, 92%) did not have diplopia before local anesthesia. Of the thirteen patients with strabismus resulting from trauma to extraocular muscles, eleven patients showed vertical rectus overaction (10 superior recti, 1 inferior rectus) and two patients, mild vertical rectus underaction. Eight patients were presumed to have sensory deviation. In the remaining patients, one patient had childhood esotropia and another, old superior oblique palsy. Three patients showed a small vertical deviation without any specific cause. CONCLUSIONS: Fifty percent of diplopia was related with the surgical trauma to extraocular muscles, in which overactions (42%) were more common than underactions (8%). Thirty-five percent of the patients were presumed to have sensory deviation, which suggested the importance of preoperative examination for strabismus as well as the explanation about the risk of postoperative diplopia before surgery.
Anesthesia, Local*
;
Diplopia*
;
Edrophonium
;
Esotropia
;
Head
;
Humans
;
Muscles
;
Orbit
;
Paralysis
;
Strabismus
;
Thyroid Function Tests
8.The Antinociceptive Effect of Intrathecal Anticholinesterase on the Formalin Test in Rats.
Gweon JUNG ; Myung Ha YOON ; Seong Wook JEONG ; Sang Hyun KWAK ; Sung Su CHUNG ; Chang Young JEONG
Korean Journal of Anesthesiology 2000;38(5):887-893
BACKGROUND: Spinal anticholinesterase has been shown to have an antinociceptive action to acute noxious stimuli. The purpose of this study was to determine the effect of intrathecal anticholinesterase on the facilitated state developed after tissue injury evoked by formalin injection. METHODS: Rats were implanted with lumbar intrathecal catheters. For nociceptive test, 50 microliter of 5% formalin solution was injected into the hindpaw. The effect of pretreatment with intrathecal neostigmine, physostigmine and edrophonium, administered 10 min before formalin injection, was observed for 60 min. For the evaluation of the effect of posttreatment with intrathecal anticholinesterase, administered 9 min after formalin injection, the response was observed for 50 min. RESULTS: Formalin injection into the paw resulted in a biphasic incidence of flinching of the injected paw. Intrathecal pretreatment with neostigmine, physostigmine and edrophonium produced a dose- dependent suppression of the flinching during phase 1 and phase 2 on the formalin test. Posttreatment with three intrathecal anticholinesterases reduced the phase 2 flinching response. CONCLUSIONS: Both pretreatment and posttreatment with intrathecal anticholinesterase produced an antinociception on the formalin test. These results point out the usefulness of anticholinesterase to acute nociception and facilitated state.
Animals
;
Catheters
;
Cholinesterase Inhibitors
;
Edrophonium
;
Formaldehyde*
;
Incidence
;
Neostigmine
;
Nociception
;
Pain Measurement*
;
Physostigmine
;
Rats*
9.The Effect of 4-Aminopyridine with Anticholinesterases on MgSO4-Rocuronium-Induced Neuromuscular Blockade in Vitro.
Kyung Ho HWANG ; Myung Hyun CHO ; Seung Taeg HONG ; Wook PARK ; Sung Yell KIM
Korean Journal of Anesthesiology 2000;38(5):855-862
BACKGROUND: The aim of this study was to evaluate the effect of 4-aminopyridine (4-AP) combined with anticholiesterase (antiChE) in antagonizing MgSO4-rocuronium-induced neuromuscualr blockade using a rat hemidiaphragm. METHODS: A hemidiaphragm with phrenic nerve was dissected and was mounted in a bath containing oxygenated Krebs solution. The phrenic nerve was stimulated supramaximally and the twitch response (0.1 Hz) was stabilized for at least 30 minutes. After maximal twitch inhibition by IC95 (concentration of 95% twitch inhibition) of rocuronium and MgSO4 20 mg was achieved, antagonistic effects of 1.6, 16 microgram/ml of edrophonium, 0.1, 1.0 microgram/ml of neostigmine, 0.5, 5.0 microgram/ml of pyridostigmine, and 0.8 microgram/ml of 4-AP combined with each of the above mentioned antiChEs were investigated. RESULTS: Whereas antiChE alone at low concentration partially recovered only the twitch response, 4-AP combined with antiChE recovered both the twitch and train-of-four responses significantly. CONCLUSIONS: 4-AP enhances antagonism of a magnesium-rocuronium induced neuromuscular blockade by edrophonium, neostigmine or pyridostigmine in vitro.
4-Aminopyridine*
;
Animals
;
Baths
;
Cholinesterase Inhibitors*
;
Edrophonium
;
Neostigmine
;
Neuromuscular Blockade*
;
Oxygen
;
Phrenic Nerve
;
Pyridostigmine Bromide
;
Rats
10.A Patient with Coexisting Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome.
Jee Ae KIM ; Young Min LIM ; Eun Hye JANG ; Kwang Kuk KIM
Journal of Clinical Neurology 2012;8(3):235-237
BACKGROUND: The coexistence of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) is very rare and remains controversial. CASE REPORT: A 48-year-old woman initially presented with noticeable right ptosis and intermittent diplopia. She then developed fluctuating proximal limb weakness and difficulty in swallowing. The serum titer of anti-acetylcholine-receptor antibody was elevated and the edrophonium (Tensilon) test was positive. However, repetitive nerve stimulation revealed abnormalities typical of LEMS. The patient exhibited a good response to treatment with anticholinesterase inhibitors and steroids, and long-term evaluation disclosed that she presented with the clinical, electrophysiological, and immunological characteristics of both diseases. CONCLUSIONS: The reported clinical and electrophysiological features suggest that this patient was a very rare case of combined MG and LEMS.
Deglutition
;
Diplopia
;
Edrophonium
;
Extremities
;
Female
;
Humans
;
Lambert-Eaton Myasthenic Syndrome
;
Middle Aged
;
Myasthenia Gravis
;
Steroids