Badrising 1996.

Methods	RCT single centre, cross‐over trial
Participants	10 participants, 7 with generalised MG and 3 with ocular MG were treated
Interventions	4.5 mg intranasal neostigmine or placebo three times a day for two consecutive weeks preceded by a baseline observation week
Outcomes	Improvement in generalised MG occurred in 2 of 5 participants with ocular symptoms, 4 of 4 with bulbar symptoms and 4 of 7 participants with impaired muscle power. Dyspnoea improved in both participants with this symptom. One participant experienced no effect. 1 of 3 participants with ocular MG had less ptosis with neostigmine. None of the participants showed improvement on placebo
Notes	One participant developed borborygmi and fasciculations after using intranasal neostigmine. The study could provide data for the primary outcome but only one of the secondary outcomes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Study in abstract form. No information regarding sequence generation available
Allocation concealment (selection bias)	Unclear risk	Study in abstract form. No information regarding allocation concealment available
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Study in abstract form. Author mentions that the study was blinded but does not describe the method
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Study in abstract form. No information regarding outcome data available
Selective reporting (reporting bias)	Unclear risk	Study in abstract form. No information regarding selective reporting available
Other bias	Unclear risk	Study in abstract form. No information available whether the study was free of other bias

RCT: randomised controlled trial
 MG: myasthenia gravis