Question Title: Occular Myasthenia

Forum: Neurology Forum
Topic: Sleep

Posted by CCF Neuro MD on July 02, 1997 at 21:38:22:

In Reply to: Occular Myasthenia posted by Amy on June 23, 1997 at 13:49:43:

: Husband is 30. Has had extreme migranes since 10, occuring once every 2 months approximately. Has been taking an imitrex shot at the onslaught of a migrane for about 2 years. For over 1 year has experienced intermittent double vision in his left eye and blurred vision in both. He has been tested by a general physician for blood sugar and blood pressure problems. He has a had a cat scan. He has seen 3 opthalmologists with no success and is seeing a allergist today. His other symptoms include fatigue and oversleeping. Otherwise he is healthy. Through internet research we found the disease Occular Myasthenia...which is treatable and in some cases leads to Mayasthenia Gravis. Sounds like what he has, but we live in Northeast Tennessee and do not have a Neurological Opthalmologist here. Is there someone relatively nearby you can refer us to or can another type physician diagnose this? Are there any other symptoms? Is there any other precautions we should take or things he should avoid? Could this be it or something else? Could the symptoms be related to imitrex? He is at his rope's end and the vision problem interferes with everyday life. Appreciate your help. Also suspect might be related to allergy to food additives such as Monosodium Glutamate, which occurs more extensively naturally in tomatoes, hard cheeses and mushrooms.

Dear Amy:

Reading the symptoms that your husband is complaining of, I agree absolutely that myasthenia gravis (MG) needs to be excluded. I doubt that allergies, foods, imitrex or MSG has a significant causative role. The diagnosis of MG (of which ocular MG is a milder subtype) is important because 1) it can be treated, 2) it can progress to a more severe and generalised form of MG, and 3) some medications/ anesthesia-related medications are better avoided in the presence of MG.
The two specialists best poised to make the diagnosis of ocular MG are a neurologist specializing in neuromuscular diseases, and a neuro-ophthalmologist. The diagnosis usually requires additional tests such as a blood test for ACh Receptor antibodies, a special EMG or electrical muscle test, and a clinical drug test called the Tensilon test.
The neurologist closest to northeast Tennessee I can think of for your husband's problem is Dr. Donald Sanders at Duke University Medical Center, Durham, NC. His phone number is (919)684-6078. Dr. Sanders is known worldwide for his research on MG. If you wish to see a neuro-ophthalmologist, I recommend Dr. Gregory Kosmorsky at the Cleveland Clinic Foundation (call (800)223-2273 and ask for his office).
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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