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March 1997

Ocular Myasthenia Gravis

Author Affiliations

St Mary's Hospital 89 Genesee St Rochester, NY 14611

Arch Neurol. 1997;54(3):229. doi:10.1001/archneur.1997.00550150005001

In their discussion of the results of a retrospective chart review of 32 patients with ocular myasthenia gravis treated with prednisone for variable periods, Kupersmith and colleagues1 neglected to mention the only controlled clinical trial of anything in myasthenia—namely, of corticotropin.2 That trial carried out more than 3 decades ago demonstrated beyond the shadow of a statistical doubt that the vehicle in which corticotropin was dissolved was as beneficial as corticotropin itself in ameliorating the symptoms and signs of ocular myasthenia.

Given the exceeding variability of myasthenia gravis,3 the worrisome character and incidence of unwanted effects from corticosteroids,4 and the real difficulty in tapering many patients' drug regimens (eg, in the present study more than half of the patients received multiple courses of prednisone and almost a fifth received such medication for more than 6 months), can the conclusion that such medications are useful, even beneficial,