Journal of Neurology

, Volume 239, Issue 3, pp 165–169

Efficacy of intranasal administration of neostigmine in myasthenic patients


  • Angelo Sghirlanzoni
    • Istituto Neurologico “C. Besta”
  • Davide Pareyson
    • Istituto Neurologico “C. Besta”
  • Claudio Benvenuti
    • Formenti SpA
  • Giovanni Cei
    • Department of NeurologyPisa University
  • Vittorio Cosi
    • Department of NeurologyPavia University
  • Mariella Lombardi
    • Department of NeurologyPavia University
  • Mariaflavia Nicora
    • Formenti SpA
  • Roberta Ricciardi
    • Department of NeurologyPisa University
  • Ferdinando Cornelio
    • Istituto Neurologico “C. Besta”
Original Communications

DOI: 10.1007/BF00833919

Cite this article as:
Sghirlanzoni, A., Pareyson, D., Benvenuti, C. et al. J Neurol (1992) 239: 165. doi:10.1007/BF00833919


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

AutoimmunityCholinesterase inhibitorsMyasthenia gravisNeostigmineIntranasal administration

Copyright information

© Springer-Verlag 1992