242	C. Gauba et al.

–Pyridostigmine 60 mg oral; neostigmine 15 mg oral, 0.5 mg IV. (These should be discontinued if the patient is ventilated and reintroduced on weaning.)

–Thymectomy may be useful especially in young (<50 years) females, but response is delayed. Its role is still being studied. It is mandatory in thymomas.

–Supportive treatment.

5.Anterior horn cell disease

•The commonest of these is amyotrophic lateral sclerosis.

•It is usually sporadic and slightly more common in males.

•Peak incidence is in 65to 74-year-old people.

•Mean disease duration from the onset to death is about 3 years.

•Wasting and weakness are usually patchy. Fasciculations are prominent. Both upper and lower motor neuron signs are seen and there is no sensory loss.

•Bulbar and respiratory muscles are involved in later stages, and respiratory failure is the usual mode of death.

•So far, there is no known drug which significantly prolongs survival.

Suggested Readings

1.Chawla J, Gruener G. Management of critical illness polyneuropathy and myopathy. Neurol Clin. 2010;28(4):961–77.

A review article.

2.Meena AK, Khadilkar SV, Murthy JM. Treatment guidelines for Guillain–Barré syndrome. Ann Indian Acad Neurol. 2011;14(Suppl 1):S73–81.

A review article.

3.Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn AF, Sibbald WJ. Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain–Barré syndrome. J Neurol Neurosurg Psychiatr. 198;649:563–73.

4.Zochodne DW, Bolton CF, Thompson RT, Driedger AA, Hahn AF, Gilbert JJ. Myopathy in critical illness. Muscle Nerve. 1986;9:652.

5.Spitzer AR, Giancarlo T, Maher L, Awerbuch G, Bowles A. Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve. 1992;15:682–6.