Ice pack test in myasthenia gravis.

*Assistant Professor, **Professor & Head, Department of Medicine, Dr. RP Govt. Medical College, Tanda, Himachal Pradesh Received: 02.04.2010; Revised: 02.11.2010; Accepted: 13.03.2013 A 38 year o ld female presented with difficulty in chewing and swallowing, drooping of both eye lids, early fatigability of upper limbs during lifting of objects and on sustained effort for five months duration. She experienced worsening of symptoms toward evening and improvement in symptoms after getting up from sleep in morning and on taking rest. On examination there was ptosis of both eye lids, more in right eye than left (Figure 1) and rest of general physical and systemic examination was normal. Haematological and biochemical profile, X-ray chest, ultrasonogram of abdomen, CT scan thorax and CPK were normal. On Ice pack application on right eye for five minutes (Figure 2), patient experienced improvement in drooping of right upper eye lid by 3 mm (Figure 3), as measured by slit lamp beam. On applying ice pack on left eye similar improvement was experienced. Patients experienced improvement on neostigmine test also. She was treated with pyridostigmin 60 mg QID ; her symptoms disappeared completely and she was advised regular follow up. In Myasthenia Gravis (MG), ocular symptoms occur in almost all patients i n s o m e p o i n t d u r i n g c o u r s e o f disease; 40% patients have extra ocular symptoms at onset. The most common the edrophonium test carries a risk of serious cardiac adverse reactions and Ice Pack Test in Myasthenia Gravis