A case of multiple sclerosis associated with defective neuromuscular transmission

A 38-year-old woman developed relapsing disseminated sclerosis associated with myasthenic syndrome. The cerebrospinal fluid showed 12 lymphocytes per 1 mul and paretic colloidal curve. The serum contained antibody against smooth muscle antigen (titre 1 : 10) but no antibody against nuclear antigen or VDRL antigen. Repetitive stimulation of the right ulnar nerve at 35 c/sec. demonstrated typical decrements between 70 and 72%. The prostigmine test showed significant diminishing of decrements. The possible immunopathological mechanism of myasthenic syndrome in multiple sclerosis was briefly discussed.