Original Communications

Journal of Neurology

, Volume 239, Issue 3, pp 165-169

First online:

Efficacy of intranasal administration of neostigmine in myasthenic patients

  • Angelo SghirlanzoniAffiliated withIstituto Neurologico “C. Besta”
  • , Davide PareysonAffiliated withIstituto Neurologico “C. Besta”
  • , Claudio BenvenutiAffiliated withFormenti SpA
  • , Giovanni CeiAffiliated withDepartment of Neurology, Pisa University
  • , Vittorio CosiAffiliated withDepartment of Neurology, Pavia University
  • , Mariella LombardiAffiliated withDepartment of Neurology, Pavia University
  • , Mariaflavia NicoraAffiliated withFormenti SpA
  • , Roberta RicciardiAffiliated withDepartment of Neurology, Pisa University
  • , Ferdinando CornelioAffiliated withIstituto Neurologico “C. Besta”

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The efficacy of intranasally administered neostigmine was tested in 22 patients with generalized myasthenia gravis (MG). Topical therapy to the highly vascularized oropharynx proved to be quickly effective in 5–15 min both clinically and electrophysiologically. Twenty-eight MG patients were then recruited from different centres and their morning doses of oral pyridostigmine were substituted with intranasal neostigmine over a period of 2 or 3 weeks. Intranasal neostigmine proved to be equally efficacious in this regimen. No side-effect was noted even in 4 patients treated in this way for 1 year. Intranasal administration of anti-acetylcholinesterase may be very beneficial: (1) for patients with irregular absorption of oral doses; (2) early in the morning and every time a fast and temporary effect is needed; (3) in bulbar impairment and emergencies, in which a handy atomizer may be life-saving.

Key words

Autoimmunity Cholinesterase inhibitors Myasthenia gravis Neostigmine Intranasal administration