Journal of neurology
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Journal of neurology · Jan 1985
Comparative StudyDo true remissions in myasthenia really exist? An electrophysiological study.
To answer the question whether true remissions in myasthenia gravis occurred, 20 patients were studied with a history of evident, typical myasthenia but in full clinical remission. Two control groups served as a comparison: one of 10 healthy volunteers and the other of 10 patients with generalized, presently active myasthenia. In 17 of the 20 patients in remission single-fibre EMG (SFEMG) abnormalities were found, indicating some subclinical disturbances of neuromuscular transmission (in 3 cases the results were overtly pathological, in 11 cases moderately pathological, and in 3 cases slightly pathological). ⋯ Three weeks later a full clinical relapse occurred. The results obtained suggest that in the majority of patients the remissions are only apparently complete. A pathological jitter in a patient in remission calls for special attention: the patient must be spared any immunological stimuli such as vaccination, injections of sera, infections etc.; no drugs can be given which may increase the neuromuscular block; an immunosuppressive course of treatment should be considered; prognosis should be reconsidered.
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Journal of neurology · Jan 1985
Long-term prognosis of subarachnoid hemorrhages of unknown etiology.
Forty-nine patients who suffered a spontaneous subarachnoid hemorrhage (SAH), and in whom panangiography did not show the cause of the bleeding, were evaluated after a long follow-up (median 8 years). No relationship was found between outcome and antifibrinolytic treatment or blood pressure level. Angiography was repeated in cases with spasm or after rebleeding: one aneurysm was found (7%). ⋯ The early mortality was 2%. Late functional capacity was normal in 94% of the patients. No particular restrictions should therefore be recommended.
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Journal of neurology · Jan 1985
Antimyotonic therapy with tocainide under ECG control in the myotonic dystrophy of Curschmann-Steinert.
Ten patients suffering from advanced myotonic dystrophy with severe myotonic symptoms were treated with 800-1200 mg/day of the anti-arrhythmic drug tocainide (Xylotocan). All patients reported a marked subjective improvement of myotonia, which was confirmed by objective tests. Except for a slight QT-prolongation in one patient, the ECG was not significantly altered by the treatment. ⋯ In these patients suffering from myotonic dystrophy with typical cardiomyopathy no deleterious effects of the drug were observed, especially no cardiac arrhythmias which would have necessitated interruption of treatment. Therefore, the authors recommend symptomatic therapy with tocainide for myotonia and paramyotonia congenita, as well as in myotonic dystrophy patients suffering from marked myotonic stiffness. ECG and 24-h ECG should be carefully recorded as necessary in any treatment with anti-arrhythmic drugs.
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Journal of neurology · Jan 1985
Case ReportsMyasthenia gravis associated with adrenocortical insufficiency. Report of two cases.
Two cases of Addison's disease associated with myasthenia gravis are reported. This association has been described only rarely in the literature. ⋯ It is most likely that the origin of the adrenocortical insufficiency in the second case is tuberculous. The pathogenetic mechanism of these associations is briefly discussed.