Management of myasthenic conditions: nonimmune issues.
OBJECTIVE
To review some management issues in myasthenic disorders that are not part of the immune interventions. These are mainly related to pharmacotherapy of these conditions and side effects of various medications, but also referred to acute management of respiration in myasthenic crises.


RESULTS
Antisense compound inhibiting acetylcholine esterase has positive therapeutic effects during short-term administration, but further studies are needed to confirm its chronic effects. Pyridostigmine seems not to have an additional effect to 3-4 diaminopyridine in Lambert Eaton myasthenic syndrome. Bilevel positive airway pressure and other external respiratory supportive systems may prevent in some myasthenic crises the need for intubation or at least shorten it. Statins can aggravate myasthenia gravis but the risk is not well quantified, and these compounds are not completely contraindicated in myasthenia.


CONCLUSIONS
Further research of the above findings is still necessary to make them a solid conclusion for the management of the myasthenias.
Argov
Zohar
Z
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. zohara@ekmd.huji.ac.il
D015761:4-Aminopyridine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077770:Amifampridine; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D004568:Electrodiagnosis; D006801:Humans; D009157:Myasthenia Gravis / Q000139:chemically induced / Q000628:therapy*; D020294:Myasthenic Syndromes, Congenital / Q000628:therapy*; D020319:Oligodeoxyribonucleotides, Antisense / Q000627:therapeutic use*; D026902:Potassium Channel Blockers / Q000627:therapeutic use; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000628:therapy
D002800:Cholinesterase Inhibitors; D020319:Oligodeoxyribonucleotides, Antisense; D026902:Potassium Channel Blockers; D015761:4-Aminopyridine; D011729:Pyridostigmine Bromide; D000077770:Amifampridine