YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==MYASTHENIA GRAVIS AND TENSILON== 3 AUTHOR Watt G AUTHOR Theakston RDG AUTHOR Hayes CG AUTHOR Yambao ML AUTHOR Warrell DA AUTHOR et al TITLE Positive response to edrophonium in patients with neurotoxic envenoming by cobras (Naja naja philippinensis): placebo controlled study SOURCE N. Engl. J. Med.; VOL 315 ISS Dec 4 1986, P1444-1448, (REF 31) ABSTRACT IPA COPYRIGHT: ASHP A placebo controlled, double blind crossover trial of intravenous edrophonium chloride (Tensilon; I) injection, 10 mg, in 10 adults, aged 16-55 yr, with neurotoxic envenomation caused by bites of the Philippine cobra (Naja naja philippinensis) was conducted. There was significantly more improvement in ptosis and endurance of upward gaze after I than placebo. Five min after injection, the mean difference (+-SD) in the percentage of the iris that was uncovered was 39+-5.47 (70 vs. 31%), and the mean difference in the number of seconds of upward gaze was 33.1+-9.29 (39.7 vs. 6.6 sec). The expiratory and inspiratory pressures, forced vital capacity, and ability to cough, speak and swallow also improved after I. In both patients who were studied electromyographically, pretreatment and postplacebo responses were typical of myasthenia gravis and became normal after I. It was concluded that anticholinesterases are beneficial in the management of neurotoxic envenomation by Asian cobras (Naja naja). 4 AUTHOR Szathmary I AUTHOR Magyar P AUTHOR Szobor A TITLE Myasthenia gravis: protective effect of ipratropiumbromide (Atrovent) on airways obstruction caused by edrophonium chloride (Tensilon). SOURCE Eur Neurol; VOL 20, ISS 1, 1981, P56-61 ABSTRACT The preventive effect of Atrovent Dosier-Aerosol on the airway flow resistance (Raw) caused by Tensilon was studied on 10 patients suffering from myasthenia gravis. Atrovent completely prevented the increase of Raw in 8 cases and considerably decreased it in 2 cases. The measure of the reaction observed may be influenced by the intensity of the cholinergic symptoms occurring on administration of Tensilon as well as by the magnitude of the initial Raw value. No side-effect which may be attributed to the administration of Atrovent could be observed, the substance did not increase the myasthenic symptoms. According to the study, Atrovent is a suitable medicine for the prevention of airway obstruction caused by Tensilon. 5 AUTHOR Scheife RT AUTHOR Hills JR AUTHOR Munsat TL TITLE Myasthenia gravis: signs, symptoms, diagnosis, immunology, and current therapy SOURCE Pharmacotherapy; VOL 1 ISS Jul-Aug 1981, P39-54, (REF 81) ABSTRACT IPA COPYRIGHT: ASHP The epidemiology, clinical presentation, etiology, pathogenesis, diagnosis and treatment of myasthenia gravis are reviewed. Guidelines for the use of Tensilon (edrophonium chloride) as a diagnostic agent are included. The mechanism of action, pharmacology, indications and adverse effects associated with anticholinesterase agents (physostigmine hydrobromide; neostigmine bromide) and the corticosteroids, when used to treat myasthenia gravis, are detailed. 1 AUTHOR Henze T TITLE [Therapy of myasthenia gravis with cholinesterase inhibitors--principles and pharmacologic monitoring] SOURCE Fortschr Neurol Psychiatr; VOL 64, ISS 3, 1996, P110-21 (REF: 92) ABSTRACT Cholinesterase inhibitors are still important in the treatment of myasthenic patients. Therapeutic principles, indications and adverse effects are discussed in detail. Methods of pharmacological monitoring had been searched over many years. Besides determination of pyridostigmine plasma concentration, erythrocyte-bound acetylcholinesterase (AChE) activity could provide a possibility to monitor therapy with cholinesterase inhibitors. 88 patients with myasthenia gravis were investigated. The results demonstrated that after pyridostigmine erythrocyte-bound as well as synaptic AChE is inhibited. Moreover, erythrocyte-bound AChE has proven to be a parameter of cholinesterase inhibitor effect. After injection of edrophonium-chloride (Tensilon) inhibition of AChE activity can be demonstrated as well. During steady pyridostigmine doses stable plasma concentrations and AChE inhibition depend on the respective dosage. Higher daily doses result in greater stability of pharmacologic parameters, whereas low daily doses lead to great interindividual differences of AChE inhibition even after equal pyridostigmine doses. Intraindividually there is no strong correlation, too. Therefore estimation of erythrocyte-bound AChE activity is not useful for routine pharmacological monitoring of cholinesterase inhibitor therapy, but may be helpful in some clinical conditions. The method provides some advantages over pyridostigmine plasma concentration, since it is applicable for other cholinesterase inhibitors, too, and since it requires less technical equipment and time.