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Eye movement fatigue in myasthenia gravis

Department of Neurology (Dr. Spooner), and the Reed Neurological Research Center, Department of Neurology (Dr. Baloh), UCLA School of Medicine, Los Angeles, California.

An 18-year-old woman presented with dissociated nystagmus that was first attributed to multiple sclerosis. When she attempted to maintain 30-degree horizontal gaze deviation in either direction, there was progressive weakness of the adducting eye and increasing amplitude of nystagmus in the abducting eye. The amplitude and maximum velocity of repetitive one-per-second 30-degree saccades progressively decreased over a 3-minute period. Intravenous edrophonium completely abolished the dissociated nystagmus and adducting muscle weakness, and returned the saccade maximum velocity to normal. Her subsequent response to pyridostigmine and thymectomy confirmed the diagnosis of myasthenia gravis.

Reprint requests should be addressed to Dr. Baloh, Department of Neurology, Reed Neurological Research Center, Center for the Health Sciences, UCLA, Los Angeles, CA 90024.

This study was supported by NIH Grant NS 09823.

Accepted for publication November 14, 1977.

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