Eliciting Latent Myasthenia Gravis Eye Signs Utilizing ‘The Mary Walker Effect’

This is the authors' abstract. We don't add key points for this paper.

Current standardized tests to induce fatigability in the Myasthenia Gravis (MG) patient do not take intoconsideration that, in real-world situations, the patient is using more than one muscle group at a time. In 1895, theGerman physician Frederick Jolly, who is famed for coining the name Myasthenia Gravis, observed that exhaustionof one group of voluntary muscles in a patient with MG induced weakness in other groups that had not beenstimulated. This phenomenon was also noted by Dr. Mary Walker and was named the Walker effect in 1938. The Novelocular motility technique described in this paper is designed to engage the extraocular muscles (EOM) simultaneouslywith another muscle group namely the facial muscles, specifically testing for lip weakness. This test was namedThe SLOW Test (Simultaneous Lip and Ocular Weakness). It was found that observable Myasthenia Gravis Eyes Signs(MGES) were quicker to elicit and more obvious when performing the SLOW Test. The SLOW Test is a methoddesigned to confirm the presence of MG signs quickly and effectively, even when there appear to be no obviousfatigable signs with current testing regimes. The test combines ‘old knowledge’ by testing for the ‘Mary WalkerEffect’ with current ophthalmic testing for MG, which increases fatigue and allows for a higher suspicion level ofgeneralized MG as another muscle group is simultaneously tested. The development of clinical methods for identifyinglatent fatigable muscle weakness is critical to reducing the cases of missed MG diagnosis, testing methods such as theSLOW Test have the potential to improve patients’ quality of life by enabling earlier diagnosis and initiating earliertreatment.