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.
Caress JB, Hunt CH. Bread-and-Butter in Diagnosis of Myasthenia Gravis—Reply. Arch Neurol. 2005;62(12):1939-1940. doi:10.1001/archneur.62.12.1939-b