Immunosuppressive treatment of rippling muscles in patients with myasthenia gravis

• Published in: Neuromuscular disorders : NMD Vol. 9; no. 8; pp. 604 - 607
• Main Authors: Müller-Felber, W, Ansevin, C.F, Ricker, K, Müller-Jenssen, A, Töpfer, M, Goebel, H.H, Pongratz, D.E
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.12.1999
• Subjects: Adult; Azathioprine - therapeutic use; Humans; Immunosuppression; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Muscle Contraction; Muscular Diseases - drug therapy; Muscular Diseases - etiology; Muscular Diseases - physiopathology; Myasthenia gravis; Myasthenia Gravis - complications; Myasthenia Gravis - drug therapy; Physical Stimulation; Pyridostigmine Bromide - adverse effects; Pyridostigmine Bromide - therapeutic use; Rippling; Immunosuppression; Myasthenia gravis; Rippling
• ISSN: 0960-8966; 1873-2364
• DOI: 10.1016/S0960-8966(99)00065-6

Rippling muscle disease is a rare autosomal dominant disorder that may occur sporadically. In this report two patients presenting with rippling muscles followed by myasthenia gravis are described. Our first patient developed rippling muscles about 1 month after infection with Yersinia enterocolitica. Two years later myasthenia gravis appeared. Our second patient had a 2-year history of asthma prior to the onset of rippling muscles which preceded the myasthenic symptoms by 4–8 weeks. Acetylcholine receptor and anti-skeletal muscle antibody titers were positive in both patients. In both patients the rippling phenomena worsened with pyridostigmine treatment but markedly improved after immunosuppression with azathioprine.