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February 1975

Regional Curare Test in Evaluation of Ocular Myasthenia

Author Affiliations

From the Myasthenia Gravis Clinic and Laboratory and the departments of neurology, medicine, and surgery, The Mount Sinai Hospital and School of Medicine of the City University of New York.

Arch Neurol. 1975;32(2):84-88. doi:10.1001/archneur.1975.00490440034004

In 7 of 14 patients with clinically restricted ocular myasthenia gravis, the regional curare test showed latent peripheral involvement. The test consisted of the intravenous administration of 0.2 mg d-tubocurarine into an ischemic arm followed by repetitive supramaximal percutaneous electrical stimulation of the median or ulnar nerves. This produced a decrease in the amplitude of the initial evoked potential and a decrement of greater than 10% in the amplitude of the succeeding three to five potentials at rates of 3, 5, or 15 stimuli/sec. Three patients underwent transcervical thymectomy with subsequent improvement in both electrical and clinical findings. Evaluation of all patients with ocular myasthenia gravis should include regional curare testing of clinically uninvolved peripheral nerves. Thymectomy should be considered for patients with abnormal results.

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