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December 2005

Bread-and-Butter in Diagnosis of Myasthenia Gravis—Reply

Arch Neurol. 2005;62(12):1939-1940. doi:10.1001/archneur.62.12.1939-b

In reply

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.