Considerable interest has arisen concerning the role of cholinergic substances in myotonia congenita and myasthenia gravis. This has been stimulated by the recognition of the important part played by acetylcholine as a chemical transmitter of the parasympathetic impulses1 and the demonstration of a specific blood esterase for its destruction.2 It has been suggested that in myotonia there is an excess production of acetylcholine or an insufficient amount of esterase and that in myasthenia there is an insufficient amount of acetylcholine or an increase in esterase. Kennedy and Wolf3 reviewed the evidence for and against these conceptions and concluded that neither adequately accounts for the facts; they suggested that the acidity of the muscle due to some metabolic disturbance may be changed sufficiently to affect the action of acetylcholine.
Determinations of values for acetylcholine esterase in the blood in cases of myasthenia gravis have given conflicting results. Stedman
PONCHER HG, WADE HW. BLOOD CHOLINE ESTERASE IN MYOTONIA CONGENITA AND MYASTHENIA GRAVIS. Arch NeurPsych. 1939;41(6):1127–1129. doi:10.1001/archneurpsyc.1939.02270180055004
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