Administration of the acetylcholinesterase inhibitor
edrophonium resulted in strong and immediate improvement of ptosis, bulbar symptoms, and limb weakness.
We did not perform IV or IM
edrophonium tests on our patient due to the possible side effects and lack of
edrophonium in our country.
Hayes et al., "Positive Response to
Edrophonium in Patients with Neurotoxic Envenoming by Cobras (Naja naja philippinensis)," The New England Journal of Medicine, vol.
In cases where snake envenomation and tick are less likely (or have been ruled out) and the index of suspicion for MG is high, the clinical response to a test dose of
edrophonium or pyridostigmine may be a good diagnostic option.
Improvement in ptosis was not observed with the
edrophonium test, upward gaze test, and ice test.
Tensilon test by injection of IV
edrophonium and demonstration of improvement of muscle weakness is usually reserved in patients with typical clinical features and negative serological and electrophysiological testing [2].
Sepsis attenuates the intensity of the neuromuscular blocking effect of d-tubocurarine and the antagonistic actions of neostigmine and
edrophonium accompanying depression of muscle contractility of the diaphragm.
ANTICHOLINESTERASE DRUGS: Renal excretion accounts for approximately 50% of the clearance of neostigmine and approximately 75% of elimination of
edrophonium and pyridostigmine.
Ordinarily, the repetitive nerve stimulation test, the
edrophonium test, anti-acetylcholine receptor antibody (anti-AChR-Ab) titers, and the ice test are used for MG diagnosis [5].
An
edrophonium chloride test was interpreted as positive for myasthenia gravis, and intravenous immune globulin treatment was initiated.