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August 1986

The Office Tensilon Test for Ocular Myasthenia Gravis

Author Affiliations

From the Departments of Neurology, Case Western Reserve University School of Medicine, Cleveland, and University Hospitals of Cleveland, and the Neurology Service, Cleveland Veterans Administration Medical Center.

Arch Neurol. 1986;43(8):843-844. doi:10.1001/archneur.1986.00520080081029

The technique for intravenous administration of Tensilon (edrophonium chloride) varies. In 1952, Osserman and Genkins1 introduced the test and recommended a 2-mg initial dose followed, if no reaction (usually cholinergic) occurred in 45 s, by the rapid administration of an additional 8 mg. Others have modified the test by waiting five minutes after the initial dose,2 by injecting Tensilon in small increments after the initial dose,2-6 or by slowly infusing the remaining 8 mg.5 Although I have recently been converted by Norman Schatz, MD, to the small-increment method, the significant controversy this essay should address is not drug administration but rather the test end point. What constitutes a "positive" Tensilon response in the physician's office where (without benefit of oculographic equipment7-10) the first Tensilon test is performed in a suspected myasthenic? Such a determination is obviously important since a positive test is virtually diagnostic of

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