Management of myasthenic conditions: nonimmune issues

Purpose of review: 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.

Recent findings: 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.

Summary: Further research of the above findings is still necessary to make them a solid conclusion for the management of the myasthenias.