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• Arq. Neuro-Psiquiatr. 14 (1) • Mar 1956 • https://doi.org/10.1590/S0004-282X1956000100002   copiar

Tratamento dos casos graves de miastenia: ação do ACTH e cortisona. Considerações a propósito de três casos

Myastenia gravis treated with ACTH and Cortisone: report of three cases

Resumos

São apresentados 3 casos de miastenia grave em que os recursos terapêuticos clássicos não deram resultado favorável. Os 3 pacientes foram, então, submetidos ao tratamento pelo ACTH e cortisona; em todos houve remissão da sintomatologia, remissão que perdurou até cêrca de um mês após a suspensão da hormonioterapia. O tratamento foi repetido várias vêzes de acôrdo com a evolução da doença. É de notar que em 2 pacientes (casos 1 e 2), foram estabelecidas doses mínimas de manutenção controladas durante cerca de 40 dias. O ACTH foi usado por via intravenosa em doses variáveis de 2,5 a 25 mg, diluído em 250 a 1000 ml de sôro glicosado isotônico, na velocidade de 20 a 25 gotas por minuto. Em todos os casos, durante a hormonioterapia, foi administrada prostigmina em doses muito pequenas.

Three cases of myastenia gravis treated with ACTH and Cortisone after failure of classic therapy, are reported. All cases were symptoms free for about one month after withdrawall of hormone therapy. According to the evolution treatment was resumed several times. A minimal maintenance dosis was tried in cases 1 and 2, controled during a period of at least 40 days. ACTH was used intravenously (2.5 to 25 mgm. in 250 to 1,000 ml. isotonic glucose solution daily) at the rate of 20 to 25 drops per minute. Prostigmine was administered simultaneously in very small dosis. Serious relapse of symptoms occurred in the first week in each series of ACTH in case 2, and after the first series in case 1. All patients had a follow-up of two years.

Tratamento dos casos graves de miastenia. Ação do ACTH e cortisona. Considerações a propósito de três casos

Myastenia gravis treated with ACTH and Cortisone. Report of three cases

José Lamartine de Assis

Docente Livre

RESUMO

São apresentados 3 casos de miastenia grave em que os recursos terapêuticos clássicos não deram resultado favorável. Os 3 pacientes foram, então, submetidos ao tratamento pelo ACTH e cortisona; em todos houve remissão da sintomatologia, remissão que perdurou até cêrca de um mês após a suspensão da hormonioterapia. O tratamento foi repetido várias vêzes de acôrdo com a evolução da doença. É de notar que em 2 pacientes (casos 1 e 2), foram estabelecidas doses mínimas de manutenção controladas durante cerca de 40 dias. O ACTH foi usado por via intravenosa em doses variáveis de 2,5 a 25 mg, diluído em 250 a 1000 ml de sôro glicosado isotônico, na velocidade de 20 a 25 gotas por minuto. Em todos os casos, durante a hormonioterapia, foi administrada prostigmina em doses muito pequenas.

SUMMARY

Three cases of myastenia gravis treated with ACTH and Cortisone after failure of classic therapy, are reported. All cases were symptoms free for about one month after withdrawall of hormone therapy. According to the evolution treatment was resumed several times. A minimal maintenance dosis was tried in cases 1 and 2, controled during a period of at least 40 days. ACTH was used intravenously (2.5 to 25 mgm. in 250 to 1,000 ml. isotonic glucose solution daily) at the rate of 20 to 25 drops per minute. Prostigmine was administered simultaneously in very small dosis. Serious relapse of symptoms occurred in the first week in each series of ACTH in case 2, and after the first series in case 1. All patients had a follow-up of two years.

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BIBLIOGRAFIA

1. WALKER, M. B. - a) Case showing effect of prostigmin on myasthenia gravis. Proc. Roy. Soc. Med., 28:759 (abril), 1935; b) Treatment of myasthenia gravis with Physostigmine. Lancet, 1:1200 (junho 12), 1934.

2. WESTERBERG, M. R.; MAGEE, K. R. - Mestinon in the treatment of myasthenia gravis. Neurology, 4:762 (outubro), 1954.

3. WESTERBERG, M. R.; MAGEE, K. R.; SHIDEMAN, E. F. - Effect of 3-hydroxyphenyldimethylamonium chloride (tensilon) in myasthenia gravis. Michigan M. Bull., 17:311, 1950.

4. WESTERBERG, M. R.; MAGEE, K. R.; SHIDEMAN, E. F. - Effect of Tensilon in myasthenia gravis. Neurology, 3:302 (abril), 1953.

5. OSSERMAN, K. E.; KAPLAN, L. I. - Rapid diagnostic test for myasthenia gravis increased muscle strenght, without fasciculations, after intravenous administration of edrophonium (tensilon) chloride. J.A.M.A., 150:265, 1952.

6. GROB, D.; HARVEY, A. M. - Observations on the effects of tetraethyl-pyrophosphate (TEPP) in man, and on its use in the treatment of myasthenia gravis. Bull. Johns Hopkins Hosp., 84: 532, 1949.

7. RIDER, J. A.; SHULMAN, S.; RICHTER, R. B.; MOELHER, H. C.; DUBOIS, K. P. - Treatment of myasthenia gravis with octamethyl-pyrophosphoramide. J.A.M.A., 145:967 (março 31), 1951.

8. SCHULMAN, S.; RIDER, J. A.; RICHTER, R. B. - Use of octamethyl-pyrophosphoramide in the treatment of myasthenia gravis. Further observations. J.A.M.A., 152:1707, 1953.

9. MINOT, A. S.; DODD, K.; RIVEN, S. S. - Use of guanidine hydrochloride in treatment of myasthenia gravis. J.A.M.A., 113:553 (agosto 12), 1939.

10. MINOT, A. S.; DODD, K.; RIVEN, S. S. - The response of the myasthenia state to guanidine hydrochloride. Science, 87:348 (abril), 1938.

11. EDGEWORTH, H. - A report of progress on the use of ephedrine in a case of myasthenia gravis. J.A.M.A., 94:1146 (abril 12), 1930.

12. TORDA, C.; WOLFF, H. G. - Effect of adrenocorticotrophic hormone of pituitary gland on ability of tissue to synthesize acetylcholine. Proc. Soc. Exper. Biol. & Med., 57:137, 1944.

13. TORDA, C.; WOLFF, H. G. - Effect of blood serum from patients with myasthenia gravis on the synthesis of acetylcholine in vitro. J. Clin. Invest., 23:649, 1944.

14. TORDA, C.; WOLFF, H. G. - Effects of organ extracts and their fractions on acetylcholine synthesis. Am. J. Physiol., 148:417, 1947.

15. TORDA, C.; WOLFF, H. G. - Effect of hypophysectomy on neuromuscular function. Am. J. Physiol., 156:274, 1949.

16. TORDA, C.; WOLFF, H. G. - Effects of adrenocorticotropic hormone on neuromuscular function in patients with myasthenia gravis. J. Clin. Invest., 28:1228, 1949.

17. SOFFER, I. J. - Effects of adrenocorticotrophic hormone (ACTH) in myasthenia gravis with tumor of thymus. J. Mt. Sinai Hosp., 15:73, 1848.

18. MILLIKAN, C. H.; EATON, L. M. - Clinical evaluation of the effect of ACTH and cortisone on myasthenia gravis. J. Lab. a. Clin. Med., 36:966, 1950.

19. MILLIKAN, C. H.; EATON, L. M. - Clinical evaluation of ACTH and cortisone in myasthenia gravis. Neurology, 1:145 (março), 1951.

20. SCHLEZINGER, N. S. - Present status of therapy in myasthenia gravis. J.A.M.A., 148:508 (fevereiro 16), 1952.

21. TORDA, C.; WOLFF, H. G. - Effects of hypophysectomy and adrenocorticotrophic hormone on neuromuscular functions and acetylcholine synthesis. Am. J. Physiol., 161:534, 1950.

22. TORDA, C.; WOLFF, H. G. - Effects of administration of the adrenocorticotrophic hormone (ACTH) on patients with myasthenia gravis. Arch. Neurol, a. Psychiat., 66:163, 1951.

23. RITTER, J. A.; EPSTEIN, N. - Myasthenia gravis. Some observations on the effects of various therapeutic agents, including thymectomy and ACTH in nine year old child. Amer. J. Med. Sc., 220:66, 1950.

24. SHY, G. M.; BRENDLER, S.; RABINOVITCH, R.; MC EACHERN, D. - Effects of cortisone in certain neuromuscular disorders. J.A.M.A., 144:1353, 1950.

Trabalho da Clínica Neurológica da Fac. Med. da Univ. de São Paulo (Prof. A. Tolosa). Entregue para publicação em agosto 1955

Clínica Neurológica. Hospital das Clinicas da Fac. Med. da Univ. de São Paulo - Caixa Postal 3461 - São Paulo, Brasil.

  • 1. WALKER, M. B. - a) Case showing effect of prostigmin on myasthenia gravis. Proc. Roy. Soc. Med., 28:759 (abril), 1935;
  • b) Treatment of myasthenia gravis with Physostigmine. Lancet, 1:1200 (junho 12), 1934.
  • 2. WESTERBERG, M. R.; MAGEE, K. R. - Mestinon in the treatment of myasthenia gravis. Neurology, 4:762 (outubro), 1954.
  • 3. WESTERBERG, M. R.; MAGEE, K. R.; SHIDEMAN, E. F. - Effect of 3-hydroxyphenyldimethylamonium chloride (tensilon) in myasthenia gravis. Michigan M. Bull., 17:311, 1950.
  • 4. WESTERBERG, M. R.; MAGEE, K. R.; SHIDEMAN, E. F. - Effect of Tensilon in myasthenia gravis. Neurology, 3:302 (abril), 1953.
  • 5. OSSERMAN, K. E.; KAPLAN, L. I. - Rapid diagnostic test for myasthenia gravis increased muscle strenght, without fasciculations, after intravenous administration of edrophonium (tensilon) chloride. J.A.M.A., 150:265, 1952.
  • 6. GROB, D.; HARVEY, A. M. - Observations on the effects of tetraethyl-pyrophosphate (TEPP) in man, and on its use in the treatment of myasthenia gravis. Bull. Johns Hopkins Hosp., 84: 532, 1949.
  • 7. RIDER, J. A.; SHULMAN, S.; RICHTER, R. B.; MOELHER, H. C.; DUBOIS, K. P. - Treatment of myasthenia gravis with octamethyl-pyrophosphoramide. J.A.M.A., 145:967 (março 31), 1951.
  • 8. SCHULMAN, S.; RIDER, J. A.; RICHTER, R. B. - Use of octamethyl-pyrophosphoramide in the treatment of myasthenia gravis. Further observations. J.A.M.A., 152:1707, 1953.
  • 9. MINOT, A. S.; DODD, K.; RIVEN, S. S. - Use of guanidine hydrochloride in treatment of myasthenia gravis. J.A.M.A., 113:553 (agosto 12), 1939.
  • 10. MINOT, A. S.; DODD, K.; RIVEN, S. S. - The response of the myasthenia state to guanidine hydrochloride. Science, 87:348 (abril), 1938.
  • 11. EDGEWORTH, H. - A report of progress on the use of ephedrine in a case of myasthenia gravis. J.A.M.A., 94:1146 (abril 12), 1930.
  • 12. TORDA, C.; WOLFF, H. G. - Effect of adrenocorticotrophic hormone of pituitary gland on ability of tissue to synthesize acetylcholine. Proc. Soc. Exper. Biol. & Med., 57:137, 1944.
  • 13. TORDA, C.; WOLFF, H. G. - Effect of blood serum from patients with myasthenia gravis on the synthesis of acetylcholine in vitro. J. Clin. Invest., 23:649, 1944.
  • 14. TORDA, C.; WOLFF, H. G. - Effects of organ extracts and their fractions on acetylcholine synthesis. Am. J. Physiol., 148:417, 1947.
  • 15. TORDA, C.; WOLFF, H. G. - Effect of hypophysectomy on neuromuscular function. Am. J. Physiol., 156:274, 1949.
  • 16. TORDA, C.; WOLFF, H. G. - Effects of adrenocorticotropic hormone on neuromuscular function in patients with myasthenia gravis. J. Clin. Invest., 28:1228, 1949.
  • 17. SOFFER, I. J. - Effects of adrenocorticotrophic hormone (ACTH) in myasthenia gravis with tumor of thymus. J. Mt. Sinai Hosp., 15:73, 1848.
  • 18. MILLIKAN, C. H.; EATON, L. M. - Clinical evaluation of the effect of ACTH and cortisone on myasthenia gravis. J. Lab. a. Clin. Med., 36:966, 1950.
  • 19. MILLIKAN, C. H.; EATON, L. M. - Clinical evaluation of ACTH and cortisone in myasthenia gravis. Neurology, 1:145 (março), 1951.
  • 20. SCHLEZINGER, N. S. - Present status of therapy in myasthenia gravis. J.A.M.A., 148:508 (fevereiro 16), 1952.
  • 21. TORDA, C.; WOLFF, H. G. - Effects of hypophysectomy and adrenocorticotrophic hormone on neuromuscular functions and acetylcholine synthesis. Am. J. Physiol., 161:534, 1950.
  • 22. TORDA, C.; WOLFF, H. G. - Effects of administration of the adrenocorticotrophic hormone (ACTH) on patients with myasthenia gravis. Arch. Neurol, a. Psychiat., 66:163, 1951.
  • 23. RITTER, J. A.; EPSTEIN, N. - Myasthenia gravis. Some observations on the effects of various therapeutic agents, including thymectomy and ACTH in nine year old child. Amer. J. Med. Sc., 220:66, 1950.
  • 24. SHY, G. M.; BRENDLER, S.; RABINOVITCH, R.; MC EACHERN, D. - Effects of cortisone in certain neuromuscular disorders. J.A.M.A., 144:1353, 1950.

Datas de Publicação

  • Publicação nesta coleção
    08 Abr 2014
  • Data do Fascículo
    Mar 1956
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