The ice test versus the rest test in myasthenia gravis

Kubis, Kenneth C; Danesh‐Meyer, Helen V.; Savino, Peter J.; Sergott, Robert C.

doi:10.1016/s0161-6420(00)00458-9

Cited by 88 publications

(64 citation statements)

References 16 publications

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“…As all patients showed clear improvement, they concluded that neither cold nor heat were responsible by the improvement, stating that rest seems to be the relevant factor of ptosis improvement. In other study, Kubis et al 25 found that in myasthenic subjects the median improvement of the ptosis with ice was statistically significant when compared with rest alone. They concluded that eyelid elevation after the ice pack test is in part caused by rest, however the ice test significantly improves ptosis more than rest alone does 25 .…”

Section: Discussionmentioning

confidence: 83%

“…In other study, Kubis et al 25 found that in myasthenic subjects the median improvement of the ptosis with ice was statistically significant when compared with rest alone. They concluded that eyelid elevation after the ice pack test is in part caused by rest, however the ice test significantly improves ptosis more than rest alone does 25 . Although cooling is able to improve the muscle strenght in myasthenic patients, decrease the muscle temperature below 22 o C is not recommended because it can cause decrease the muscle fiber contraction force, rather than improve the neuromuscular transmission 26 .…”

Section: Discussionmentioning

confidence: 83%

“…In the other hand, the specificity of the ice pack test is very high considering that it is not positive in other diseases that can simulate MG such as oculomotor nerve palsy, oculopharingeal muscular dystrophy and mitochondrial myopaties 1 . False-positive results were virtually not seen 10,19,21,24,25 . In a large study with 156 patients comparing ice pack test with the edrophonium test, the ice test had sensitivity and specificity of 100% 8 .…”

Section: Discussionmentioning

confidence: 90%

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Ice pack test in the diagnosis of myasthenia gravis

Almeida

Radaeli

Melo

2008

Arq. Neuro-Psiquiatr.

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Myasthenia gravis (MG) is the most frequent neuromuscular transmission disorder with incidence of 2-20 patients per million. Its pathophysiology is autoimmune, with acetylcholine receptors (AChR) autoantibodies damaging the post-synaptic fold at the muscle membrane. MG often presents with isolated ocular symptoms, including diplopia and ptosis, at least at the onset. Even in patients with generalized symptoms, ocular signs occur in almost all patients in some point during the course of the disease. In up to 15% of the patients the disease remains confined to the eyes 1 . Other clinical features include bulbar symptoms (dysphagia, dysarthria), proximal limb muscles weakness and fatigue. Unusual presentations as distal limb muscles weakness can also be found in a minority of cases 2,3 . The main characteristic of the MG is the fluctuating weakness during the day, being milder during the morning and more severe at the evening. Physical activity usually worsens the weakness. The diagnostic confirmation of MG is often challenging. The tests usually performed to confirm the diagnosis of MG are the edrophonium test (Tensilon®), repetitive nerve stimulation (RNS), single fiber EMG and serum acetilcholine receptors (AchR) antibodies. The most traditional bedside diagnostic test for myasthenia gravis is the edrophonium test. It has been considered diagnostic of MG in the past, however false-positive results have been reported in other neurologic disorders like amyotrophic lateral sclerosis, botulism and brain tumor 4,5 . Furthermore, it carries a risk of serious cardiac adverse reations. Its sensitivity is about 86% in pure ocular disease 6 . Unfortunately it is not easily available in Brazil. Another bedside test that can be done is the sleep test, however this test is time consuming and probably not practical for the busy physician, since the patient has to take a nap of 15 to 20 minutes in a dark room for clinical comparison 7 . The other complementary tests have variable sensitivity and specificity. The diagnostic field of the RNS and AchR antibodies for pure ocular disease is quite low. The AChR antibodies are the most specific test for myasthenia gravis, however the sensitivity varies from 56% in pure ocular myasthenia according to Tabassi et al. 8 to 70% in Oh et al. 9 study. The repetitive nerve stimulation has even lesser sensitivity, varying from 35% in distal muscles to 45% in proximal muscles 10 . The most sensitive test for ocular myasthenia is single fiber EMG, reaching up to 80% in pure ocular cases and 95% in generalized disease 9 , however its specificity is low, the test is expensive, technically demanding and not widely available.The ice pack test is a very simple, safe and cheap procedure that can be performed by the physician at the bedside 10 . Moreover, the ice pack test does not require medications or expensive equipment and is free of adverse effects 11 . It consists of the application of an ice pack on the patient symptomatic eye for 3 to 5 minutes. The response is positive when there is improv...

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 90%

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Ice pack test in the diagnosis of myasthenia gravis

Almeida

Radaeli

Melo

2008

Arq. Neuro-Psiquiatr.

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“…Esta teoria é contestada por alguns autores. Outros autores concluíram que a aplicação do gelo é parcialmente responsável pela abertura da fenda palpebral (15) . Segundo estes autores, o repouso durante os dois minutos de crioterapia também auxiliaria na melhora da função muscular.…”

Section: Discussionunclassified

Teste do gelo no diagnóstico de miastenia gravis

Fonseca¹,

Lucci²,

Rehder³

2010

Arq. Bras. Oftalmol.

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“…In a study of edrophoniumpositive patients all had positive sleep tests as well (Odell et al 1991). A small, randomized trial compared the ice test to the rest test and found that the median improvement of ptosis with the rest test was 2 mm and with the ice test 4.5 mm, but no improvement found among www.intechopen.com patients without MG (Kubis et al 2000). One value of these tests is that they may be performed in patients in whom edrophonium infusion is contraindicated.…”

Section: Other Clinical Evaluationsmentioning

confidence: 99%