Quantitative correlation between plasma pyridostigrnine levels and neuromuscular function in myasthenia gravis

Milner-Brown, H. S.; Mellenthin, Michael; Sharma, Meenaxi; Miller, Robert G.

doi:10.1212/wnl.37.5.800

Cited by 9 publications

(1 citation statement)

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“…Upper and lower extremities were analyzed separately. Arm outstretched time [5,27] was measured in seconds (max. 60) at baseline and after 6 and 12 months of treatment.…”

Section: Clinical Testingmentioning

confidence: 99%

High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study

Walter

Lochmüller

Toepfer

et al. 2000

Journal of Neurology

195

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Sporadic inclusion body myositis (s-IBM) is an acquired inflammatory muscle disease of unknown cause. In general, s-IBM presents with slowly progressive, asymmetric weakness, and atrophy of skeletal muscle. There is a mild transitory or nil responsiveness to standard immunosuppressive treatment. A controlled cross-over study of 22 s-IBM patients over 3 months showed a partial improvement in those treated with high-dose intravenous immunoglobulin therapy (IVIG) versus placebo. The present study included 22 patients aged 32-75 years and with a mean duration of disease of 5.2+/-3.6 years. They were randomized by a double-blind, placebo-controlled, cross-over design to monthly infusions of 2 g/kg bodyweight IVIG or to placebo for 6 months each, followed by the alternative treatment. After 6 and 12 months the response to treatment was evaluated, using a modified Medical Research Council scale, Neuromuscular Symptom Score (NSS), the patient's own assessment of improvement, arm outstretched time, and electromyography. No serious side effects were seen, in particular no viral infection and no major cardiac or neurological complications. Overall there was no progression of the disease in 90% of patients, unlike that which might have been expected in untreated patients. A mild and significant improvement (11%) in clinical symptoms was found using NSS, but not with other test procedures. There was a trend to mild improvement in treated patients when using other tests. Individual responses to treatment was heterogeneous. The validity of this study may be reduced by mismatch of groups with regard to age at onset and variability in disease expression. The findings of this study largely confirm those of a previous IVIG trial. Treatment with IVIG may be mildly effective in s-IBM by preventing disease progression or inducing mild improvement. Long-term studies are needed to evaluate further the benefit of IVIG therapy in s-IBM.

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“…Upper and lower extremities were analyzed separately. Arm outstretched time [5,27] was measured in seconds (max. 60) at baseline and after 6 and 12 months of treatment.…”

Section: Clinical Testingmentioning

confidence: 99%

High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study

Walter

Lochmüller

Toepfer

et al. 2000

Journal of Neurology

195

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Determination of erythrocyte-bound acetylcholinesterase activity for monitoring pyridostigmine therapy in myasthenia gravis

Henze¹,

Nenner

Michaelis

1991

J Neurol

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Monitoring of pyridostigmine therapy in patients with myasthenia gravis is not routinely performed, since the daily pyridostigmine doses are adjusted to the patient's actual clinical status rather than to pyridostigmine plasma concentrations (PPC). Moreover, PPC determination is time-consuming and needs much technical equipment. Since pyridostigmine reversible blocks acetylcholinesterase (AChE) at the neuromuscular junction, we studied the correlation between the enzyme's blood activity (erythrocyte-bound AChE) and PPC, on the one hand, and between blood AChE activity and the clinical status of the individual patient, on the other. In five previously untreated patients with myasthenia gravis blood AChE activity decreased in accordance with the actual PPC after a single oral dose of 60 mg pyridostigmine (group A). Amelioration of the clinical status corresponded to the decrease of AChE activity in the same way. In another five patients, who were on stable pyridostigmine medication for at least 1 week, AChE activity and PPC were constant during the day (group B). Since it is easier to perform than PPC, our results suggest that the determination of AChE activity may be superior to measuring PPC for monitoring cholinesterase inhibitor therapy in selected cases.

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Benefits from sustained-release pyridostigmine bromide in myasthenia gravis: Results of a prospective multicenter open-label trial

Sieb

Köhler

2010

Clinical Neurology and Neurosurgery

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Quantitative correlation between plasma pyridostigrnine levels and neuromuscular function in myasthenia gravis

Cited by 9 publications

References 0 publications

High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study

High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study

Determination of erythrocyte-bound acetylcholinesterase activity for monitoring pyridostigmine therapy in myasthenia gravis

Benefits from sustained-release pyridostigmine bromide in myasthenia gravis: Results of a prospective multicenter open-label trial

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