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Monday, March 2, 2015
Exelon or Aricept to treat MG
I have a patient with known h/o and dx MG, recently underwent pacemaker placement, now being c/o feeling very tired, fatigue and muscles weakness, doing AchR AB test or MuK AB or tensilon test, once you have the disease it is usefull?, would you start Prednisone on this patient now or wait for those test. Thanks for your time.
In such a situation, I would ask two clinical questions: 1) What are the grounds for the DX of MG? 2) Is there evidence that MG is currently an active problem?
Serological testing applies to question #1 but it will not answer question #2. I rely on history, exam, neurophysiology testing and respiratory function testing to answer the second (and most important) question. Often we face a tough decision and have to carefully weigh the risk and benefits of a treatment plan. Getting second opinions and reviewing your case, in person, with a colleague who has much experience with MG may help you sort this out.
Best of luck.
John G Quinlan, MD
Professor of Neurology
College of Medicine
University of Cincinnati