Campbell M J, Simpson E, Crombie A L, Walton J N
J Neurol Neurosurg Psychiatry. 1970 Oct;33(5):639-46. doi: 10.1136/jnnp.33.5.639.
The value of electronystagmography (ENG) and of tonography in monitoring the beneficial effect of edrophonium chloride (Tensilon) on the extraocular muscles in myasthenia gravis has been assessed. Studies were performed on 17 patients with myasthenia gravis and on 18 control subjects, of whom nine had extraocular muscle weakness due to myopathic or neurogenic lesions.Electronystagmography recorded the repetitive following movements of the eyes elicited during optokinetic nystagmus. Neuromuscular fatigue with the subsequent beneficial response to Tensilon was clearly seen in 50% of patients with myasthenia. False positive responses were not seen in control subjects but in many of these, as in the remaining myasthenic patients, the amplitude and rate of nystagmus seen in the ENG was very variable. These difficulties suggest that the ENG is of limited value as a diagnostic test in myasthenia gravis.Tonography, recording the intraocular pressure of the eye continuously over four minutes, was found to be of considerable value. We found that the intraocular pressure fell on average by 1·6 to 1·8 mm Hg over a one minute period in the control recordings but increased by a mean of 1·6 mm Hg in patients with myasthenia, with a peak effect 35 seconds after Tensilon. In only one patient was there a complete failure of response. This patient, and also another woman who showed a less striking response, had severe myasthenia with a fixed ocular weakness. It is suggested that an absence of any increase in tension with Tensilon may be seen in patients with permanent neostigmine-resistant myopathic change. A small false positive response was seen on one occasion only in a patient with a sympathetic nerve lesion.Tensilon tonography, as a simple painless procedure, would appear to be of considerable value in the diagnosis of ocular myasthenia and also as a diagnostic test in the exclusion of myasthenia as a cause of isolated extraocular neuromuscular weakness.
已评估眼震电图（ENG）和眼压描记法在监测氯化腾喜龙（腾喜龙）对重症肌无力眼外肌有益作用方面的价值。对17例重症肌无力患者和18例对照者进行了研究，其中9例对照者因肌病或神经源性病变导致眼外肌无力。眼震电图记录了视动性眼震期间诱发的眼睛重复性跟随运动。50%的重症肌无力患者可明显观察到神经肌肉疲劳以及随后对腾喜龙的有益反应。对照者未出现假阳性反应，但其中许多人与其余重症肌无力患者一样，眼震电图中观察到的眼震幅度和速率变化很大。这些困难表明，眼震电图作为重症肌无力的诊断测试价值有限。眼压描记法可连续四分钟记录眼内压，结果发现其具有相当大的价值。我们发现，对照记录中眼内压在一分钟内平均下降1.6至1.8毫米汞柱，而重症肌无力患者平均升高1.6毫米汞柱，腾喜龙给药后35秒达到峰值效应。只有一名患者无反应。该患者以及另一名反应不明显的女性患有严重的重症肌无力且存在固定性眼肌无力。提示永久性新斯的明抵抗性肌病改变的患者使用腾喜龙后可能看不到眼压升高。仅在一名交感神经病变患者中偶尔出现一次小的假阳性反应。腾喜龙眼压描记法作为一种简单无痛的检查方法，在眼型重症肌无力的诊断以及排除重症肌无力作为孤立性眼外神经肌肉无力病因的诊断测试中似乎具有相当大的价值。
