Myasthenia Gravis

05 November 2004

Blood Tests

FBE, UCE, Ca, Mg, PO4, LFT, glucose

CK

TFT

ANA, ENA, ESR

Ach (acetylcholine) receptor antibody

Electrophysiology

Repetitive nerve stimulation

Single fibre EMG (if repetitive nerve stimulation negative or inconclusive)

Tensilon test

See protocol

Marker can be improvement in eye excursion

                                                            Electrophysiology

                                                            Vital capacity

                                                            Muscle strength

Ice pack test

Apply ice pack to eye with ptosis for 2 minutes to see whether ptosis resolves or improves. (This is essentially a reverse Uhthoff's phenomenon in the peripheral nervous system).

Imaging

CXR

CT chest: check for thymoma

Extras

Antistriated muscle antibody (thymoma association): titin, myosin, actin, alpha actinin.

Ryanodine receptor antibody (thymoma association)