STUDIES IN MYASTHENIA GRAVIS

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Abstract
IN THE patient with myasthenia gravis weakness may develop either as an inherent part of the disease or from overtreatment with anticholinesterase. The differentiation of these two types of weakness presents a difficult and serious problem, often unrecognized in the management of the patient with myasthenia gravis. The rapidity with which this weakness may lead to fatal termination justifies the use of the terms "myasthenic crisis" and "cholinergic crisis." When the weakness is extreme and is due to the disease, it is called "myasthenic crisis"; when the weakness is extreme and is due to overtreatment with anticholinesterase, it is called "cholinergic crisis." A method for differentiating these reactions is offered by the edrophonium chloride (Tensilon) test.1 Cholinergic crises have become more frequent in recent years, since the advent of a number of organic esters of phosphoric acid derivatives in the treatment of myasthenia gravis. These drugs are diisopropyl fluorophosphate,