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

Department of Neurology/Neummuscular Research (Drs. Milner-Brown and Mellenthin), Children's Hospital of San Francisco, and the Departments of Neurology (Dr. Miller) and Anesthesia (Dr. Sharma), University of California, San Francisco, CA.

In 10 patients with myasthenia gravis, we studied the relationship between plasma pyridostigmine levels and five measures of neuromuscular function (NMF) following single oral doses of 60 to 120 mg. The NMF measures were percent decrement of the evoked muscle compound potential, maximum force, force-time integral, vital capacity, and outstretched-arm time. The combined mean improvement was most significant 2 hours after pyridostigmine ingestion and coincided with the peak plasma pyridostigmine levels in eight patients. In seven patients, there was a positive correlation between plasma pyridostigmine levels and the mean percent improvement.

Address correspondence and reprint requests to Dr. Milner-Brown, Department of Neurology/Neuromuscular Research (OPR 504), Children's Hospital of San Francisco, 3700 California Street, San Francisco, CA 94119.

Supported by the Zimmerman Foundation of Children's Hospital of San Francisco and the California Chapter, Myasthenia Gravia Foundation. M.A. Mellenthin was a Dr. Henry R. Vieta Myasthenia Gravis Fellow.

Received May 5, 1986. Accepted for publication in final form August 27, 1986.

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