Pease W S, Lagattuta F P
Arch Phys Med Rehabil. 1987 Sep;68(9):568-70.
In patients with myasthenia gravis, vigorous exercise and electric stimulation produce weakness that is usually reversed by rest. We describe a case of persistent weakness in a 31-year-old woman with myasthenia gravis following therapeutic electric stimulation. She was injured in an automobile accident, with cervical and lumbar muscle strain diagnosed by a local emergency room physician. She consulted a chiropractor two days later because her symptoms had not abated. The chiropractic treatment of short-wave diathermy, high-voltage electric stimulation and spinal manipulation continued thrice weekly for six weeks. She then presented to her neurologist, complaining of persistent fatigue, weakness, increased diplopia, cervical and occipital pain, and disrupted sleep. Neck weakness had developed since her last visit. She was admitted to the hospital for evaluation. Neurologic exam showed no other abnormality of strength, sensation, or reflexes. The exacerbation of myasthenia responded to prednisone and increased pyridostigmine. After two months she required only her preinjury dose of pyridostigmine (60 mg q.d. p.r.n.) to prevent diplopia or fatigue, and her strength was normal. Repeated electrically induced muscle contraction is suspected of causing this exacerbation of myasthenia gravis.
在重症肌无力患者中，剧烈运动和电刺激会导致肌无力，而休息通常可使其恢复。我们描述了一例31岁重症肌无力女性患者在接受治疗性电刺激后出现持续性肌无力的病例。她在一场车祸中受伤，当地急诊室医生诊断为颈部和腰部肌肉拉伤。两天后，由于症状未减轻，她咨询了一名脊椎按摩师。脊椎按摩治疗包括短波透热疗法、高压电刺激和脊柱推拿，每周进行三次，持续六周。然后她去看了神经科医生，主诉持续疲劳、肌无力、复视加重、颈部和枕部疼痛以及睡眠紊乱。自上次就诊以来，颈部出现了肌无力。她因评估而入院。神经系统检查未发现力量、感觉或反射方面的其他异常。重症肌无力的加重对泼尼松和增加的吡啶斯的明有反应。两个月后，她仅需服用受伤前剂量的吡啶斯的明（60毫克，每日一次，必要时服用）来预防复视或疲劳，且她的力量恢复正常。怀疑反复的电诱导肌肉收缩导致了此次重症肌无力的加重。
