Although it has been more than 20 years since Moehlig first used adrenal cortical extracts in the treatment of a patient with myasthenia gravis and reported "dramatic improvement"1 the usefulness of corticotropin (ACTH) and corticosteroids in the treatment of this disease remained unsettled. Osserman2 described them as "drugs to be used with extreme caution," and Schwab3 considered them "still of questionable value."
Why is there not a clearer understanding of the efficacy of these agents? This is partly because of the vagaries of the disease, ranging from apparently spontaneous remissions to sometimes equally sudden relapses. It is partly because of enthusiasms, the enthusiasm of the patient with his fervor to respond to a new treatment and the enthusiasm of the physician with his eagerness to help his patient. And partly, emphasized by the vagaries and the enthusiasms, it is because of inadequate trials. Perusal of the published
MOUNT FW. Corticotropin in Treatment of Ocular Myasthenia: A Controlled Clinical Trial. Arch Neurol. 1964;11(2):114–124. doi:10.1001/archneur.1964.00460200010002
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