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Simpson Test
Simpson test is a clinical test used in neurology to determine ocular myasthenia gravis. It was first described by the Scottish neurologist John Alexander Simpson (neurologist), John Alexander Simpson. Procedure In myasthenia gravis, there is a variable weakness of skeletal muscles, which is exacerbated by repeated contraction. To cause sustained contraction of levator palpebrae superioris muscle, the patient is asked to gaze upward for an extended period of time, without lifting the head. After a few minutes, the patient with myasthenia gravis starts to show drooping of upper eyelids, while normal individuals do not show any drooping. Thus, this test can be used to clinically differentiate between ocular myasthenia gravis and normal individuals. Since myasthenia gravis affects all skeletal muscles, eyelid drooping is often bilateral. It is sometimes done in conjunction with tensilon test, where edrophonium is injected to look for reversibility of eyelid drooping. In myaesthenia gra ...
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Myasthenia Gravis
Myasthenia gravis (MG) is a long-term neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking. Onset can be sudden. Those affected often have a large thymus or develop a thymoma. Myasthenia gravis is an autoimmune disease of the neuro-muscular junction which results from antibodies that block or destroy nicotinic acetylcholine receptors (AChR) at the junction between the nerve and muscle. This prevents nerve impulses from triggering muscle contractions. Most cases are due to immunoglobulin G1 (IgG1) and IgG3 antibodies that attack AChR in the postsynaptic membrane, causing complement-mediated damage and muscle weakness. Rarely, an inherited genetic defect in the neuromuscular junction results in a similar condition known as congenital myasthenia. Babies of mothers with myasthe ...
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John Alexander Simpson (neurologist)
John Alexander Simpson (November 3, 1916 – August 31, 2000) was an American physicist and science educator. He was deeply committed to educating the public and political leaders about science and its implications, most notably as a principal founder of the '' Bulletin of the Atomic Scientists'' and a long-time member of the organizations Board of Sponsors.''Eugene N. Parker'', National Academies Press"John Alexander Simpson BIOGRAPHICAL MEMOIRS" Visited 10 February 2020. He is known for inventions such as the gas flow α-particle proportional counter (for measuring plutonium yields in the presence of high intensity fission products), and the neutron monitor, and for having several of the instruments he created launched into space, such a dust flux monitor aboard the '' Stardust'' spacecraft.''Pearce Wright'', The Guardian"John Simpson" Thursday 14 September 2000. Visited on August the 28th, 2010. Simpson spent his career as an instructor and researcher for the University ...
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Levator Palpebrae Superioris
The levator palpebrae superioris ( la, elevating muscle of upper eyelid) is the muscle in the orbit that elevates the upper eyelid. Structure The levator palpebrae superioris originates from inferior surface of the lesser wing of the sphenoid bone, just above the optic foramen. It broadens and decreases in thickness (becomes thinner) and becomes the levator aponeurosis. This portion inserts on the skin of the upper eyelid, as well as the superior tarsal plate. It is a skeletal muscle. The superior tarsal muscle, a smooth muscle, is attached to the levator palpebrae superioris, and inserts on the superior tarsal plate as well. Blood supply The levator palebrae superioris receives its blood supply from branches of the ophthalmic artery, specifically, muscular branches and the supraorbital artery. Blood is drained into the superior ophthalmic vein. Nerve supply The levator palpebrae superioris receives motor innervation from the superior division of the oculomotor nerve. The smoo ...
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Tensilon Test
A tensilon test, also called an edrophonium test, is a pharmacological test used for the diagnosis of certain neural diseases, especially myasthenia gravis. It is also used to distinguish a myasthenic crisis from a cholinergic crisis in individuals undergoing treatment for myasthenia gravis. Procedure A 10 mg edrophonium chloride syringe and a 2 mg atropine syringe are prepared. Atropine is prepared for immediate use in case cholinergic crisis occurs. After a neurologic examination and recording of vital signs, 2 mg edrophonium is injected intravenously. After waiting 30 seconds and ensuring that no adverse reactions have occurred, the remaining 8 mg of edrophonium is also injected. The patient is then asked to perform repetitive tasks, (i.e. lifting an object or repeatedly opening and closing their eyelids). Under the influence of edrophonium, patients with myasthenia gravis are able to complete these tasks more easily and with more strength than before the inj ...
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Edrophonium
Edrophonium is a readily reversible acetylcholinesterase inhibitor. It prevents breakdown of the neurotransmitter acetylcholine and acts by competitively inhibiting the enzyme acetylcholinesterase, mainly at the neuromuscular junction. It is sold under the trade names Tensilon and Enlon (according to FDA Orange Book). Clinical uses Edrophonium (by the so-called Tensilon test) is used to differentiate myasthenia gravis from cholinergic crisis and Lambert-Eaton. In myasthenia gravis, the body produces autoantibodies which block, inhibit or destroy nicotinic acetylcholine receptors in the neuromuscular junction. Edrophonium—an effective acetylcholinesterase inhibitor—will reduce the muscle weakness by blocking the enzymatic effect of acetylcholinesterase enzymes, prolonging the presence of acetylcholine in the synaptic cleft. It binds to a Serine-103 allosteric site, while pyridostigmine and neostigmine bind to the AchE active site for their inhibitory effects. In a chol ...
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Electromyography
Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyograph detects the electric potential generated by muscle cells when these cells are electrically or neurologically activated. The signals can be analyzed to detect abnormalities, activation level, or recruitment order, or to analyze the biomechanics of human or animal movement. Needle EMG is an electrodiagnostic medicine technique commonly used by neurologists. Surface EMG is a non-medical procedure used to assess muscle activation by several professionals, including physiotherapists, kinesiologists and biomedical engineers. In Computer Science, EMG is also used as middleware in gesture recognition towards allowing the input of physical action to a computer as a form of human-computer interaction. Clinical uses EMG testing has a variety of ...
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