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This controversy is not about the usefulness of the Tensilon test in the diagnosis of ocular myasthenia gravis but is about technique and interpretation. Dr Seybold describes in careful detail the technique, advocating the use of the Lancaster red-green test that "allows the examiner to confirm and quantitate the diplopia." Dr Daroff disagrees, pointing out that these tests are indirect and subjective in that they do not measure muscle strength but diplopia, which depends on the patient's interpretation and reporting. Dr Daroff further warns against "perverse" positive test results, especially in evaluating ocular motility, a caution shared by Dr Seybold.
Dr Seybold does not advocate double-blind testing with saline solution because the tests "double the time required... but add little to its accuracy." That may be true for unequivocal cases, but it is precisely in the less dramatic ones that the precaution of a baseline response becomes most rewarding.
Hachinski V. The Tensilon Test. Arch Neurol. 1986;43(8):844. doi:https://doi.org/10.1001/archneur.1986.00520080082030
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