THE MANAGEMENT of patients with severe myasthenia gravis which does not improve by anticholinesterase medication often poses a difficult therapeutic problem. Ineffectiveness of anticholinesterase drugs as a result of infection may be transient and may be managed by treating the infection with general supportive measures, particularly respiratory assistance. When the ineffectiveness is long-lasting, reduction or withdrawal of anticholinesterase drugs, assisting respiration at the same time when necessary, is sometimes followed by return of therapeutic response to anticholinesterase drugs.1 Improvement in muscle strength and in effectiveness of anticholinesterase drugs may also occur following corticotropin therapy or thymectomy.
Corticotropin therapy has been administered generally as a "short, intensive course" for 10 to 20 days with daily injections intramuscularly or intravenously of 80 to 200 units.2-6 In most patients with severe, generalized myasthenia gravis, muscle strength and effectiveness of anticholinesterase drugs decrease during the course, but increase above the initial
Shapiro MS, Namba T, Grob D. Corticotropin Therapy and Thymectomy in Management of Myasthenia Gravis. Arch Neurol. 1971;24(1):65–71. doi:10.1001/archneur.1971.00480310093009