Abstract: Myasthenia gravis (MG) is an autoimmune antibody-mediated disorder which causes fluctuating weakness in ocular, bulbar and limb skeletal muscles. There are two major clinical types of MG. Ocular MG (OMG) affects extra ocular muscles associated with eye movement and eyelid function and generalized MG results in muscle weakness throughout the body. Patients with OMG have painless fluctuating extra ocular muscles weakness, diplopia and ptosis accompanied by normal visual acuity and pupillary function. Frequently, patients with OMG develop generalized MG over 24 months. Pure OMG is more often earlier in onset (<45 years) than generalized MG. It can also occur as part of an immune-genetic disorder or paraneoplastic syndrome related to thymus tumors. Diagnosis is based on clinical manifestations, laboratory findings, electrophysiological evaluation and pharmacologic tests. Therapeutic strategies for MG consist of symptom relieving medications (e.g., acetylcholine esterase inhibitors), immunosuppressive agents, and surgical intervention (e.g., thymectomy).

Background: Patching an eye for a period of 2 hours results in a period of plasticity where inter-ocular balance shifts in favor of the patched eye. Acetylcholine has been shown to improve visual function and augment adult neural plasticity. Here we evaluate whether administering the cholinesterase inhibitor donepezil enhances the magnitude or duration of the patching induced shift in ocular balance.

Methods: We used a double-blind drug treatment design to test the effect of donepezil and patching on the shift in ocular balance. We used a well-known binocular phase combination task to measure ocular balance before and after treatment.

Results: Our results demonstrate that donepezil does not enhance, and may actually reduce the magnitude and duration of the patching-induced shift in ocular balance.

Conclusions: Patching induced adult neural plasticity does not appear to be modulated by the cholinergic system, however, increased dose or longer drug administration periods may yield significant results. Future studies on binocular rivalry are in the pipeline.