Schlömer Ella, Stein Elisa, Kedor Claudia, Rust Rebekka, Brock Anna, Wittke Kirsten, Scheibenbogen Carmen, Kim Laura
Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz, Berlin, Germany.
Experimental and Research Center (ECRC), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz, Berlin, Germany.
Front Neurosci. 2025 Sep 3;19:1637838. doi: 10.3389/fnins.2025.1637838. eCollection 2025.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a multisystemic disease characterized by exertional intolerance and fatigue which is often accompanied by muscle weakness and fatiguability. A study showed efficacy of the acetylcholinesterase inhibitor pyridostigmine on cardiac output in ME/CFS patients. Pyridostigmine is currently used off-label in ME/CFS and postural orthostatic tachycardia syndrome.
We evaluated the effect of pyridostigmine on hand grip strength in 20 patients with post-infectious ME/CFS. Hand grip strength testing was performed ten times using an electric dynamometer and was repeated after 1 h. In a second test, 30 mg of pyridostigmine was given immediately after the first measurement. Orthostatic function was assessed using a passive standing test. Neurological examination and autoantibody testing were performed to rule out a diagnosis of myasthenia gravis.
All patients had reduced maximum hand grip strength with a median of 16.45 kg (IQR: 11.45 kg-22.8 kg). Hand grip strength was diminished by a median of 4.65 kg after 1 h. In contrast, 1 h after pyridostigmine administration, patients showed an improvement in maximum hand grip strength with a median increase of 2.6 kg. The maximum hand grip strength after exertion was about 1.5-fold higher with then without pyridostigmine ( 0.01). The increase in heart rate from lying to standing was median 17 beats per minute without pyridostigmine (IQR: 13 beats per minute - 23 beats per minute) and 13 beats per minute (IQR: 9 beats per minute - 20 beats per minute) ( = 0.017) with pyridostigmine. None of the patients tested positive for myasthenia gravis specific autoantibodies.
Pyridostigmine exerts an immediate effect on muscle strength and orthostatic function. This may be attributed to increased acetylcholine availability at neuromuscular junctions, and its augmentation of parasympathetic tone.
肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）是一种多系统疾病，其特征为运动不耐受和疲劳，常伴有肌肉无力和易疲劳性。一项研究显示乙酰胆碱酯酶抑制剂吡啶斯的明对ME/CFS患者的心输出量有疗效。吡啶斯的明目前在ME/CFS和体位性直立性心动过速综合征中属于超说明书用药。
我们评估了吡啶斯的明对20例感染后ME/CFS患者握力的影响。使用电子测力计进行10次握力测试，并在1小时后重复测试。在第二项测试中，在第一次测量后立即给予30毫克吡啶斯的明。使用被动站立测试评估直立功能。进行神经学检查和自身抗体检测以排除重症肌无力的诊断。
所有患者的最大握力均降低，中位数为16.45千克（四分位间距：11.45千克 - 22.8千克）。1小时后握力中位数降低了4.65千克。相比之下，给予吡啶斯的明1小时后，患者的最大握力有所改善，中位数增加了2.6千克。服用吡啶斯的明后运动后的最大握力比未服用时高出约1.5倍（P = 0.01）。未服用吡啶斯的明时，从卧位到站立时心率增加中位数为每分钟17次（四分位间距：每分钟13次 - 23次），服用吡啶斯的明时为每分钟13次（四分位间距：每分钟9次 - 20次）（P = 0.017）。所有患者的重症肌无力特异性自身抗体检测均为阴性。
吡啶斯的明对肌肉力量和直立功能有即时作用。这可能归因于神经肌肉接头处乙酰胆碱可用性增加及其副交感神经张力增强。
