MESTINON CRISIS

MY WIFE 42 YO had blurring of vision 3 months  prior to this letter. she complained of blurring of vision and easy fatiguability. opthalmologist referred her to a local neurologist with an impression of MG. She was admitted and instead of tensilon test was done she was given pyridostigmine IV. She claimed that she improved (vision and weakness) temporarily. She was then treated as MG patient with oral mestinon 30 mg tid. after the taking the oral medications the following symptoms were noted: tachycardia, increase blood pressure, fasciculations, stomach cramps, vomiting, muscle weakness and tremors. Symptoms become prominent usually 15-20 minutes after taking the medication. she was in the hospital for 4 days and was discharged. after 2 days she was readmitted, she fainted at the  washroom. she stayed for another 7 days at the hospital. Still the medication were continued however this time she was given anti-hypertensive medications PRN for increase BP (calcibloc 5mg PRN SL). After the disachrge patent condition still did not improve. She has been taking mestinon for 3 weeks with the same dosage. after her follow-uyp check-up the attending finally discontinued the mestinon. she was given Iterax and Propanolol 40mg bid. At present she still has muscle weakness, easy fatiguability, muscle fasciculations, tachycardia, hypertension and bluured vision. I am considering that she was misdiagnosed and is having mestinon toxicity. I am planning to have her rechecked here in the states.
any opinions regarding her case would be very helpfull. thank you.

[Annie62]

vicentew,

I was worked up for myasthenia gravis in the past, and I don't understand why a neurologist would think your wife has MG based on blurred vision and easy fatigueability (or even muscle weakness if she had that prior to the Mestinon) unless she had other symptoms you didn't mention (double vision, trouble swallowing, difficulty breathing, drooping eyelid, etc.).  There are lots of things that cause excess fatigue and blurred vision (and even muscle weakness).  I think it is a good idea that you are getting a second opinion regarding the MG.  Did she have the AchR antibody test (blood test) done for myasthenia?  There are other blood tests, too, I think, but I'm not sure what they are--less definitive than the AchR, I believe--and I think the AchR antibody test is positive in about 85% of those with MG.  And there are other (non-bloodwork)  tests in addition to the tensilon test that are sometimes donw.  Do her symptoms (weakness) get worse with heat?  Sometimes heat exacerbates the weakness from MG.