Fiberoptic endoscopic evaluation of swallowing with simultaneous Tensilon application in diagnosis and therapy of myasthenia gravis

J Neurol. 2008 Feb;255(2):224-30. doi: 10.1007/s00415-008-0664-6. Epub 2008 Jan 28.


Background: Dysphagia is a common symptom in myasthenia gravis (MG). Clinical examination alone fails to detect and grade myasthenic dysphagia sufficiently. For a more precise examination of swallowing function in myasthenia gravis additional technical tools are necessary.

Objective: To investigate the diagnostic and therapeutic impact of fiberoptic endoscopic evaluation of swallowing with simultaneous Tensilon application (FEES-Tensilon Test) in myasthenia gravis.

Methods: FEES-Tensilon Test was performed following a standardized protocol. Four severely affected patients with dysphagia as their leading symptom were examined. Dysphagia was characterized by five salient endoscopic findings: leakage, delayed swallowing reflex, penetration, aspiration and residues. If a normalisation or at least an improvement of swallowing function occurred shortly after Tensilon administration the FEES-Tensilon Test was rated as being positive.

Results: In three patients the FEES-Tensilon Test successfully detected MG-related dysphagia. In one patient with dysphagia caused by oculopharyngeal muscular dystrophy the FEES-Tensilon Test was truly negative. Beside an early diagnosis of MG-related dysphagia, the FEES-Tensilon Test was useful in the differentiation between myasthenic and cholinergic crisis and in guiding treatment decisions. In all patients the FEES-Tensilon Test was superior to clinical evaluation of dysphagia. No severe side effect occurred while performing the FEES-Tensilon Test.

Conclusion: The FEES-Tensilon Test is a suitable tool in the diagnosis and therapy of myasthenia gravis with pharyngeal muscles weakness.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Cholinesterase Inhibitors* / therapeutic use
  • Conscious Sedation
  • Deglutition / physiology*
  • Deglutition Disorders / etiology
  • Diplopia / etiology
  • Edrophonium*
  • Electric Stimulation
  • Electrophysiology
  • Endoscopy
  • Female
  • Fiber Optic Technology
  • Food
  • Humans
  • Middle Aged
  • Muscle Fatigue / physiology
  • Myasthenia Gravis / diagnosis*
  • Myasthenia Gravis / physiopathology
  • Neurologic Examination
  • Pyridostigmine Bromide / therapeutic use
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy
  • Thymectomy
  • Tracheostomy


  • Cholinesterase Inhibitors
  • Edrophonium
  • Pyridostigmine Bromide