Table 2.
Review of literature and treatment.
| Year | Article | Electromyography (EMG) | Abs | Other MG Tests | PD Treatment | MG Treatment |
|---|---|---|---|---|---|---|
| 1987 | Neurology 1987; 37 (5): 832–833; [6] | Orbicularis oculi 1–5 Hz decrement | Anti-AchR positive | Positive Edrophonium test | THP | Pyridostigmine 180 mg q.d., THP—stopped, thymectomy |
| 1991 | Srp. Arh. Celok. Lek. 1991 Mar–Apr; 119 (3–4): 103–6; [7] | Deltoid and bilateral facial muscle decrement | No data | |||
| 1993 | Clin. Neurol. Neurosurg. 1993; 95 (2): 137–l39; [8] | No data | Anti-AchR positive | Positive Edrophonium test | THP + Sinemet |
1. Pyridostigimine 240–360 mg q.d—led to improvement of ptosis and dysphagia only; 2. Prednisolone 60 mg q.d. until improvement |
| 2003 | J. Neurol. 2003; 250: 766–767; [9] | No data | No data | |||
| 2008 | Parkinsonism. Relat. Disord. 14 (2): 164–165; [10] | Increased jitter in orbicularis oculi, neck extensors | Negative anti-AchR and anti-Musk | Positive Neostigimine test | No PD treatment | 1. Pyridostigmine 60 mg q.d.+ Prednisolone 50 mg/d + Azathioprine (AZA) 125 mg q.d.—slight improvement 2. Plasmaferesis six sessions 3. Prednisolone 5 mg + Pyridostimine |
| 2009 | Movement Disorders, Vol. 24, No. 13, 2009; 2025–2026; [11] | Increased jitter in left frontalis muscle | Negative anti-AchR | Positive Neostigimine test | No PD treatment | Pyridostigmine 60 mg × 4/d —significant improvement |
| 2011 | Neurologist 2011; 17(3): 144–146; [12] | Decrement > 25% | Anti-AchR positive |
Not performed | Levodopa + Benserazide (250 mg q.d.) |
1. intravenous Immunoglobulin (ivIg)—five days 2. Piridostigmine—180 mg q.d.—led to improvement after three months |
| 2014 | The Neurohospitalist 2014, Vol. 4 (3): 117–118; [13] | No data | 1.anti-AchR, anti-striational and AchR modulating positive; 2.negative |
Not performed | 1.—Levodopa + Carbidopa 2.—no treatment |
1. Pyridostigmine + AZA—stopped because of adverse reactions then—ivIg 2 g/kg every six weeks for eight years; 2. Pyridostigmine in small dose—led to improvement |
| 2014 | Neurol. Sci. 2014. 35 (5): 797–799; [14] | Decrement | Anti-AchR positive | Not performed | No data | Pyridostigmine 60 mg × 4/d + Prednisolone 10 mg—followed by a dose increase of Prednisolone to 75 mg—led to improvement of rheumatoid arthritis |
| 2016 | Parkinsonism. Relat. Disord. 2016; 28: 166–168; [15] | Increased jitter in orbicularis, extensor and digitorumcomunis | 1. and 2. negative anti-AchR; 3. anti—AchR positive |
Positive Neostigimine test | No data | Pyridostigmine 15–30 mg q.d.—in all cases, led to improvement without further progression |
| 2016 | J. ClinAnesth. 2016; 34: 350–351; [16] | No data | No data | Levodopa+ Benserazide |
Pyridostigmine 60 mg × 4/d | |
| 2016 | Geriatr. Gerontol. Int. 2016; 16 (4): 528–530; [17] | Increased jitter and decrement > 20% | Negative Anti-AchR | Positive Neostigimine test | Levodopa | 1. Pyridostigmine 60 mg × 3/d + Prednisone 30 mg q.d.+ AZA 100 mg q.d 2. After one week ivIg 0.5 mg/kg was started—led to improvement |
| 2016 | J. Neurol. Disord. 2016, 4:4; [18] | Decrement 3 Hz | anti-AchR positive | Positive Neostigimine test | Levodopa | Pyridostigimine 120 mg —significant improvement |
| 2016 | JAmGeriatr Soc. 2016;64 (10): e120–e122; [19] | Decrement 3 Hz in trapezius | anti-AchR positive | Positive Edrophonium test | Levodopa+ Carbidopa |
Pyridostigmine 60 mg q.d.+ Prednisone 30 mg q.d.—significant improvement |
| 2017 | J. Neurol. Sci. 2017; 376: 216–218; [20] | Myopathic pattern | anti-AchR positive | Not performed | Levodopa | 1. Pyridostigmine led to dysphagia and dysarthria improvement, but not in the head drop; 2. ivIg—led to no benefit Steroids not tried |
| 2018 | Nervenartz. 2018:89 (4): 443–445; [21] | No decrement in all four cases | anti-AchR positive | Positive Edrophonium test in all cases | 1.—Pyridostigmine 240 mg q.d + Prednisolone 20 mg q.d + AZA 2.5 mg/kg/d followed by ivIg; 2.—Pyridostigmine 330 mg q.d. + Prednisolone 20 mg q.d; 3.—Pyridostigmin 120 mg q.d.+ Prednisolone 10 mg—significant improvement; 4.—Pyridostigmine bromide 210 mg q.d. + ivIg for five days (0.4 g/kg)—significant improvement |
|
| 2019 | Clin. Neurol. Neurosurg. 2019; 179: 1–3; [22] | Decrement 3Hz in deltoid muscle | anti-AchR positive | Positive Ice and Intrastigimine test | Levodopa + Carbidopa |
Pyridostigmine + Prednisone +AZA |
Abbreviations: AZA—Azathioprine; ivIg—intravenous immunoglobulin; THP—Trihexyphenidyl; q.d.—quaque die (once a day); Ab—antibody; AchR—acetylcholine receptor; ADM—abductor digiti minimi; Anti-MusK—anti-muscle specific tyrosine kinase; MG—Myasthenia Gravis; PD—Parkinson’s disease; Hz—Herz.