Abstract
We thank Dr. Silvestri for the comment on our article1 and agree that a relatively high proportion of patients showed discordant results between the ice pack test and single-fiber electromyography (SF-EMG) because they were observed in 15% of patients with a final diagnosis of ocular myasthenia (OM). Most of discordant cases were related to the negativity of the ice pack test in the presence of an altered SF-EMG result. One explanation could be the lack of repetition of the ice pack test, as we outlined in the discussion. Indeed, a previous study showed that repeated ice pack tests improved sensitivity by 34.6% compared with a single test.2 We also found that the repetition of the ice pack test in some patients increased its sensitivity and, therefore, the number of patients showing concordant results (unpublished data).
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