Medical Suggestion Wanted

Posted By  CCF Neuro MD on October 29, 1997 at 11:56:24:

In Reply to: Medical Suggestion Wanted posted by Sahadeolal Dearah on October 27, 1997 at 01:05:01:

: Dear Sir,
  I am 74 years old Indian suffering from inability to read fine prints due to drooping of left eyelid which has been diagnosed as Myasthenia gravis disease by doctors hers since October 1994. In the past I have suffered from cerebellar ataxia with nystagmus due to ischaemia. I also have got hypertension and ischemic heart disease. I had a complete A.V Block and a permanent Pacemaker was implanted on August 1993.
  At present I am taking:
  1 Cardules (Nifedipine) 10mg - twice daily
  2. Colsprin (Aspirin) 100mg - once daily
  3. Monotrate 20mg - twice daily
  For last two years for my mysathenia gravis I have been taking Prostigimine orally about 30mg - 60 mg per day as per my need and has been comfortable with my eyes enabling me to perform my daily routine. Recently my drooping has worsened even with 60 mg of prostigmine. I have no other complaints such as in chewing , in swallowing or in breathing.
  I would like to have some suggestions and recommendations on the following:-
  1. What are the side effects of Prostigmine or interaction if any with the other drugs I am taking?
  2. What could be the other remedial measures to prevent myasthenia gravis from aggravating and affecting other organs?
  3. What role does mercury has in this disease?
  4. Any other information which could be helpful to me
  Hope to hear from you soon.
  Thanking you
  Sahadeolal Deorah
  25 Ballygunj Park
  Rajinigandha Apt.
  Calcutta-700019

[CF-Neuro-MD]

Hello Sahadeolal,
Thank you for your interests!  To answer some of your questions, The medicine that you have been taking with your
Prostigmine do not seem to interfere with its' function so there does not seem to be any need to change your other medications.  
The prostigmine can be helpful for a while and then seem to not work as well for many reasons, one being that the body gets "used " to it and gets tolerant of it so it is not an effective.  
This is the type of drug that needs a periodic "holiday".  It may help to take a higher dose but this also needs to be discussed with your physicain.  Mestinon is a simialr form of the medication and there are longer acting forms of Mestinon that may be helpful for your drooping eyes.
You may alos want ot take the medicatin before you know that you want o read or plan your timeing of the medication dosing according to your plans of the day.
As far as Mercury goes, there are problems that it can cause but Myasthenia is not one of them.  Mercury can cause a mental problem and neuropathy but not weakness like Myasthenia patients have.
Myasthenia does not affect other organs like you asked, it is an antibody that is formed against a receptor of your meuscles so that makes it difficult for your muscles to work correctly.  It does not affect the muscles of the heart or intestines as it only affects the meuscles that help us move.
So I hope that this is helpful, I would talk with your doctor about Mestinon or Pyridostigmine as this has a longer time of action and fewer intestinal side effects.  Good Luck!