The Hazard of Cholinergic Crisis During Treatment of Myasthenia Gravis With Octamethyl Pyrophosphoramide

Case Reports1 September 1952THE HAZARD OF CHOLINERGIC CRISIS DURING TREATMENT OF MYASTHENIA GRAVIS WITH OCTAMETHYL PYROPHOSPHORAMIDECHARLES W. WILSON, M.D., JOHN P. WILLIAMS, M.D., F.A.C.P., DAVID H. MILLER, M.S.(Biochem.)CHARLES W. WILSON, M.D.Search for more papers by this author, JOHN P. WILLIAMS, M.D., F.A.C.P.Search for more papers by this author, DAVID H. MILLER, M.S.(Biochem.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-37-3-574 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOctamethyl pyrophosphoramide (OMPA), a potent anticholinesterase, was first synthesized and shown to exhibit insecticidal activity by Schrader1in Germany in 1948. Studies by DuBois, Doull and Coon2revealed that this compound was converted by the liver into an agent which inhibited peripheral cholinesterase activity but had no effect on the brain cholinesterase, thus causing no symptoms referable to stimulation of the central nervous system. This selective peripheral action renders octamethyl pyrophosphoramide (OMPA) more desirable for the treatment of myasthenia gravis than those alkyl phosphates which inhibit both central and peripheral cholinesterase. Since atropine will not antagonize the central effects of...Bibliography1. Schrader G: The development of new insecticides, final report. British Intell. Object. Sub-Comm., No. 714, rev'd 63, 1947, cited in Rider, J. A., and others. Google Scholar2. DuBoisDoullCoon KPJJM: Studies on the toxicity and pharmacological action of octamethyl pyrophosphoramide, J. Pharmacol. and Exper. Therap. 99: 376 (July) 1950. MedlineGoogle Scholar3. RiderSchulmanRichterMoellerDuBois JASRBHCKP: Treatment of myasthenia gravis with octamethyl pyrophosphoramide, J. A. M. A. 145: 967 (March 31), 1951. CrossrefMedlineGoogle Scholar4. DuBoisMangum KPGH: Effect of hexa-ethyltetraphosphate on cholinesterase in vitro and in vivo, Proc. Soc. Exper. Biol. and Med. 64: 137 (Feb.) 1947. CrossrefMedlineGoogle Scholar5. GoodmanGilman LA: The pharmacological basis of therapeutics, 1941, The Macmillan Co., New York. Google Scholar6. WoodDickensRizzoloBayliss JRPFJMW: Treatment of nerve-gas casualties, U. S. Armed Forces M. J. 2: 1609 (Nov.) 1951. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Richmond, Virginia*Received for publication April 4, 1952.From the Medical Service, McGuire Veterans Administration Hospital, Richmond, Virginia.Sponsored by the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions published by the authors are a result of their own study and do not necessarily reflect the opinion or policy of the Veterans Administration.Octamethyl pyrophosphoramide for this study was supplied by Dr. C. G. Weigand, Head of Medical Department, Eli Lilly & Company. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited by?Crisis? in myasthenia gravis: An historical perspectiveEnzymes of Acetylcholine MetabolismCHANGES IN RESPIRATORY MECHANICS IN MYASTHENIA GRAVIS WITH THERAPYCrisis in Myasthenia GravisThe developmemt of myasthenia gravis after removal of thymomaThe long-acting anticholinesterase drugs in the management of myasthenia gravisTHYMECTOMY DURING RESPIRATORY FAILURE IN A CASE OF MYOPATHY WITH MYASTHENIA GRAVISManagement of myasthenic and cholinergic crisesMyasthenia GravisSTUDIES IN MYASTHENIA GRAVIS: PRESENT STATUS OF THERAPY WITH OCTAMETHYL PYROPHOSPHORAMIDE (OMPA)*KERMIT E. OSSERMAN, M.D., F.A.C.P., LAWRENCE I. KAPLAN, M.D. 1 September 1952Volume 37, Issue 3Page: 574-579KeywordsCentral nervous systemCholinergicsEatingGratitudeLiverMedical servicesMyasthenia gravisPatientsPharmacologyPhosphates ePublished: 1 December 2008 Issue Published: 1 September 1952 PDF downloadLoading ...