정맥 투여 네오스티그민 검사를 이용한 눈중증근무력증의 진단
Intravenous Neostigmine Test for Diagnosis of Ocular Myasthenia Gravis
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 두눈 복시 환자에서 눈중증근무력증을 감별하기 위해 시행된 교대프리즘가림검사 병행 정맥 투여 네오스티그민 검사의 유용성을 보고하고자 한다. 대상과 방법: 눈중증근무력증으로 인한 복시가 의심되는 환자 26명을 대상으로 심전도 감시하에 네오스티그민을 정맥 투여하였다. 네오스티그민 정맥 투여 5, 10, 15, 20, 30분 뒤 제일눈위치에서 원거리 사시각을 교대프리즘가림검사로 측정하였고, 눈꺼풀각막반사간거리도 함께 측정하였다. 결과: 26명 중 7명에서 네오스티그민 검사 양성 결과를 보여 눈중증근무력증으로 진단하였다. 6명은 제일눈위치에서 사시가 있었고 5명은 눈꺼풀처짐이 있었다. 사시가 있었던 6명 모두에서 네오스티그민 투여 후 사시각 감소를 보였다. 사시와 눈꺼풀처짐이 동반되었던 1명에서는 사시각 감소는 있었으나 눈꺼풀처짐의 호전은 없었다. 양성 결과를 보였던 환자들에서 그 효과는 평균적으로 10-15분 사이에 최고점에 도달하였다. 결론: 눈중증근무력증이 의심되는 복시 환자에서 정맥 투여 네오스티그민 검사법은 임상에서 빠르고 안전하게 시행할 수 있는 검사법이다. 눈꺼풀각막반사간거리의 측정 및 교대프리즘가림검사를 이용한 사시각의 측정을 통하여 눈꺼풀처짐과 사시를 객관적으로 평가한다면 네오스티그민 검사의 위음성 결과를 줄여줄 것으로 기대된다.
Abstract
Purpose: In the present study, we evaluated the validity of intravenous neostigmine administration combined with alternate prism cover test (APCT) measurement as a confirmatory diagnostic method for confusing cases of myasthenia gravis with ocular involvement. Methods: Neostigmine was administered intravenously in 26 suspicious myasthenic diplopia patients under electrocardiographic monitoring. Distance deviation at primary position was evaluated with APCT at 5, 10, 15, 20, and 30 minutes after intravenous injection of neostigmine. Margin reflex distance was also evaluated at each time point. Results: Seven of 26 patients were diagnosed as myasthenic diplopia based on a positive neostigmine test. Among these patients, 6 had strabismus at the primary position and 5 patients had ptosis. In patients who showed positive results, all 6 patients showed improvement of strabismus. However, ptosis was not improved in 1 patient. The improvement of strabismus and ptosis reached a peak at 10 to 15 minutes after neostigmine administration. Conclusions: Intravenous neostigmine administration combined with APCT is a rapid, objective and safe method in hard-to-diagnose cases of myasthenia gravis with ocular involvement. When performing the neostigmine test for myasthenia gravis with ocular involvement, not only the lid position but also strabismus should be evaluated quantitatively to avoid a false negative results.
참고문헌 (17)
- Viets HR, "Prostigmin in the diagnosis of myasthenia gravis", N Engl J Med, 213, pp.1280~1283 (1935)
- Tether JE, "Intravenous neostigmine in diagnosis of myasthenia gravis", Ann Intern Med, 29, pp.1132~1138 (1948)
- Calvey TN, "Pharmacokinetics and pharmacological effects of neostigmine in man", Br J Clin Pharmacol, 7, pp.149~155 (1979)
- Sommer N, "Ocular myasthenia gravis. A critical review of clinical and pathophysiological aspects", Doc Ophthalmol, 84, pp.309~333 (1993)
- Osserman KE, "Ocular myasthenia gravis", Invest Ophthalmol Vis Sci, 6, pp.277~287 (1967)
- Luchanok U, "Ocular myasthenia: diagnostic and treatment recommendations and the evidence base", Curr Opin Neurol, 21, pp.8~15 (2008)
- Costa J, "Repetitive nerve stimulation in myasthenia gravis--relative sensitivity of different muscles", Clin Neurophysiol, 115, pp.2776~2782 (2004)
- Golnik KC, "An ice test for the diagnosis of myasthenia gravis", Ophthalmology, 106, pp.1282~1286 (1999)
- Ellis FD, "Extraocular muscle responses to orbital cooling (ice test) for ocular myasthenia gravis diagnosis", J AAPOS, 4, pp.271~281 (2000)
- Chatzistefanou KI, "The ice pack test in the differential diagnosis of myasthenic diplopia", Ophthalmology, 116, pp.2236~2243 (2009)
- Oey PL, "Ocular myasthenia gravis: the diagnostic yield of repetitive nerve stimulation and stimulated single fiber EMG of orbicularis oculi muscle and infrared reflection oculography", Muscle Nerve, 16, pp.142~149 (1993)
- Padua L, "SFEMG in ocular myasthenia gravis diagnosis", Clin Neurophysiol, 111, pp.1203~1207 (2000)
- Vincent A, "Acetylcholine receptor antibody as a diagnostic test for myasthenia gravis: results in 153 validated cases and 2967 diagnostic assays", J Neurol Neurosurg Psychiatry, 48, pp.1246~1252 (1985)
- Lindstrom JM, "Antibody to acetylcholine receptor in myasthenia gravis Prevalence, clinical correlates, and diagnostic value", J Neurology, 51, pp.933~ (1998)
- Oda K, "Myasthenia gravis: antibodies to acetylcholine receptor in ocular myasthenia gravis", J Neurol, 225, pp.251~258 (1981)
- Jacob S, "Presence and pathogenic relevance of antibodies to clustered acetylcholine receptor in ocular and generalized myasthenia gravis", Arch Neurol, 69, pp.994~1001 (2012)
- Meriggioli MN, "Autoimmune myasthenia gravis:emerging clinical and biological heterogeneity", Lancet Neurol, 8, pp.475~490 (2009)