Neurological Disorders

The Iced Drink Test - A Bedside Test for Diagnosis of Bulbar Myasthenia

Abstract

Nishit Sawal

The diagnosis of Myasthenia gravis (MG) is chiefly based on clinical symptoms and neurological examination coupled with serological testing for the presence of auto-antibodies, electrodiagnostic studies consisting of repetitive nerve stimulation test (RNST) and single fiber electromyography (SFEMG) and pharmacologic tests such as the edrophonium test. The ice pack test, based on the scientific principle that cooling improves neuromuscular transmission in Myasthenia gravis (MG), is a low cost, sensitive and specific test used for differentiating myasthenic ptosis from other causes of ptosis.

Based on the same principle, we propose the iced drink test as a quick, bedside test for differentiating bulbar weakness caused by myasthenia gravis from other causes of lower motor neuron type of bulbar weakness. The iced drink test, if validated, can prove to be useful in quick diagnosis of bulbar myasthenia.