Tensilon test

Tensilon Test

 

Definition

Tensilon is the trade name for edrophonium chloride. The Tensilon test is an injection of edrophonium chloride used to diagnosis myasthenia gravis (MG).

Purpose

Tensilon blocks the action of an enzyme, acetylcholinesterase, an important part of the system regulating neuromuscular transmission. To stimulate a muscle, a nerve cell (neuron) releases the chemical acetylcholine. To prevent prolonged muscle response to a single nerve signal, acetylcholine is broken down by acetylcholinesterase after the muscle is stimulated.
In myasthenia gravis, there are too few receptors for acetylcholine on the muscle. The acetylcholine is broken down before it can fully stimulate this reduced number of receptors, and, as a result, the muscle is weak. By blocking the action of acetylcholinesterase, Tensilon prolongs the muscle stimulation, and temporarily improves strength. Increased strength following an injection of Tensilon strongly suggests a dignosis of MG. The Tensilon test is most effective when easily observed weakness is present, and is less useful for vague or fluctuating complaints.

Precautions

The Tensilon test may cause heart rhythm abnormalities, especially in those patients with preexisting conditions.

Description

The Tensilon test involves the intravenous injection of a small amount of Tensilon. The needle is left in place. If no adverse reaction is observed within 30 seconds, an additional volume is injected. Results are apparent within one minute.

Preparation

Before the test, the patient must stop taking all drugs that can inhibit acetylcholinesterase. The referring physician can advise on specific drugs the patient is taking.

Aftercare

The effects of Tensilon subside quickly, and are completely gone after 30-60 minutes. No aftercare is needed.

Risks

Atrial fibrillation and bradycardia are possible in sensitive individuals. The administering physician must have appropriate resuscitative equipment available.

Normal results

In a patient without MG, the Tensilon test will not produce an obvious increase in a previously weak muscle. Some subjective feelings of increased strength are possible but not significant.

Abnormal results

An obvious increase in strength in weakened muscles strongly suggests the diagnosis of myasthenia gravis. The effect comes on very rapidly, and fades within minutes.

Resources

Organizations

Muscular Dystrophy Association. 3300 East Sunrise Drive, Tucson, AZ 85718. (800) 572-1717. http://www.mdausa.org.
Myasthenia Gravis Foundation of America. 222 S. Riverside Plaza, Suite 1540, Chicago, IL 60606. (800) 541-5454. http://www.med.unc.edu.

Key terms

Acetylcholine — a molecule released by neurons at the neuromuscular junction that causes muscle contraction.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

Tensilon® test

Neurology A clinical test used in Pts with known myasthenia gravis to distinguish between a myasthenic and cholinergic crisis. See Myasthenia gravis, Myasthenic crisis.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

Tensilon test

(tĕn′sĭ-lŏn″)
A test used in the diagnosis of myasthenia gravis (MG). A short-acting anticholinesterase drug, such as edrophonium chloride or neostigmine, is injected, and the patient is observed for improved muscular strength. The patient is also observed after an injection of a placebo (e.g., saline). Improvement with the active drug, but not the placebo, is a strong indication of MG.
Medical Dictionary, © 2009 Farlex and Partners
References in periodicals archive ?
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].
She later developed acute ophthalmoplegia with bilateral ptosis, at which time she was diagnosed using electromyography (EMG) and the Tensilon test. Initial AChR antibodies (binding, blocking, modulating) returned negative; however, MuSK antibody titers returned positive with titer levels of 1: 5210.
However, Tensilon test (TT) and electromyography (EMG) were both suggestive of generalized MG, excluding the congenital myasthenic syndromes and other conditions mimicking MG.
Tensilon test was suggestive of MG, and acetylcholine receptor antibody (anti-AChR) test was positive.
The present study has several limitations; for instance, seronegative MG patients included 85.5% of all patients and false negatives could not be defined using other diagnostic examinations, such as electromyogram, Neostigmine test, and Tensilon test. Moreover, anti-AChR-Ab levels were only detectable in about 50% of patients with OMG [18].
The diagnosis of MG was confirmed by means of electromyography, the presence of anti-nicotinic antibodies in the serum, and a positive Tensilon Test. Patients averaged 50 years of age (SD = 12.28; range 18-69), 14 years of education (SD = 3.21; range 10-19), and 8 years (SD = 6.50) since MG onset.
The common diagnostic test is using the anticholinesterase edrophonium (tensilon test) or neostigmine for reversal of muscle weakness.
Clin = diagnosis based only on fatiguable muscle weakness; pharm = positive Tensilon test; AChR = positive acetylcholine receptor antibody assay; RNS = >10% decremental response on repetitive nerve stimulation.
A provisional diagnosis of MG was given to the patient and this was later confirmed through a positive tensilon test and a positive blood test for ACH antibodies.
The diagnosis is primarily made using the Tensilon test. Tensilon (edrophonium chloride) is a fast-acting anticholinesterase drug with a short duration.
These tests may include a brain scan, spinal fluid examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia gravis.