Herrmann C
Calif Med. 1970 Sep;113(3):27-36.
Two disorders of neuromuscular transmission producing muscle weakness and easy fatigability which may confront the physician are myasthenia gravis and the myasthenic syndrome. The former has early symptoms and signs of oculobulbar and then extremity weakness with rapid decline of action potential and contractile strength with repetitive use and nerve-muscle stimulation. Anticholinesterases improve strength. The myasthenic syndrome has early symptoms and signs of pelvic girdle, pectoral girdle and proximal limb muscle weakness. This is worst when first starting to use or carry out nerve muscle stimulation in the rested muscles. It improves significantly for a time with use or on rapid stimulation, and then declines with continued activation. Deep tendon reflexes are sluggish or absent. Small cell carcinoma of the lung is often associated. Guanidine improves the strength. Other features and possible underlying mechanisms of the two disorders help to differentiate and treat them.
医生可能会遇到的两种导致肌肉无力和易疲劳的神经肌肉传递障碍是重症肌无力和肌无力综合征。前者有眼外肌和球部症状及体征，随后出现肢体无力，重复使用和神经肌肉刺激时动作电位和收缩力迅速下降。抗胆碱酯酶可改善肌力。肌无力综合征有骨盆带、胸带和近端肢体肌肉无力的早期症状及体征。在休息的肌肉中刚开始使用或进行神经肌肉刺激时最为严重。使用或快速刺激时肌力会在一段时间内显著改善，然后随着持续激活而下降。深腱反射迟钝或消失。常与肺小细胞癌相关。胍可改善肌力。这两种障碍的其他特征和潜在机制有助于对其进行鉴别和治疗。
