Distal myasthenia gravis with a decrement, an increment, and denervation.

We present two patients with distal myasthenia gravis poorly responsive to immunomodulatory therapy. In addition to a typical decrement on slow repetitive nerve stimulation, both had borderline to low compound muscle action potential (CMAP) amplitudes, a large increment in CMAP amplitude and area after exercise, and active denervation in distal muscles. Both had elevated acetylcholine receptor antibody (AChR Ab) levels, but normal voltage-gated calcium channel antibody levels. We hypothesize that these electrophysiological findings represent a more severe form of myasthenia gravis.

Clozapine as a treatment for psychosis in Parkinson's disease: a review.

Psychotic symptoms such as visual hallucinations and delusions are a relatively common clinical problem in patients with Parkinson's disease (PD). A dilemma arises in the treatment of psychosis in these patients because traditional antipsychotics are dopaminergic antagonists that worsen the motor symptoms of PD. Clozapine, an atypical antipsychotic, has been successfully used in the treatment of psychosis in PD patients. The use of clozapine in these patients differs significantly, however, from its use in young, relatively healthy, treatment-resistant schizophrenic patients in the dosage required, side effects, and other aspects of management.