This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Pyridostigmine (PYD), a cholinesterase inhibitor and the drug of choice for myasthenia gravis (MG), has been used safely in pregnant myasthenic patients for more than 50 years. Although it has not been associated with teratogenic effects in humans, PYD can produce growth retardation in rat pups.1 It passes readily into the fetal circulation. PYD levels in infants of myasthenic mothers were 85 to 90% of maternal plasma concentrations, whereas levels in the amniotic fluid were even higher.2 This makes the dosing of PYD a critical issue for the fetus.
We present the findings of an infant with respiratory distress and microcephaly who was exposed to more than four times the recommended dose of PYD during gestation.
Case report.
The patient’s mother is a 24-year-old primigravida woman who was diagnosed with MG at 10 years of age. She had undergone thymectomy and received multiple courses of plasmapheresis. Her only medication during her pregnancy was PYD. Because her diplopia and ptosis did not improve, her dose of PYD was increased steadily to the point that she was taking five to 10 tablets (60 mg each) every 3 hours—an average of 1,500 to 3,000 g/day, or four to eight times the recommended daily dose. Despite little improvement, this dose was continued for the entire pregnancy. She had regular prenatal visits and denied smoking …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
