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Ask Your Doctor
| Q. | How dangerous are alcoholic beverages for myasthenics? |
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| A. | In my own practice, I
try to discourage my patients with myasthenia gravis from using alcohol-containing
beverages. Certainly alcohol has an overall relaxing effect and sometimes, depending on how critically balanced the patient with MG is strengthwise, this may be enough of a "relaxant" effect to compound or otherwise accentuate their weakness both generally and/or focally. Many of the patients with MG have generalized weakness which can thus be worsened by the use of alcohol. Some of the patients with MG will also have what we refer to as bulbar paresis—this is weakness of the muscles in and about the mouth, throat, tongue. These patients usually have difficulty with their speech, swallowing, breathing and with the protective reflexes of coughing, choking and gagging. Our concern here is that with the use of alcoholic beverages these muscles would be further "relaxed" and thereby worsen the function of these already impaired muscles resulting in perhaps aspiration or even choking to death. Other concerns with the myasthenic patient who may use alcohol would include perhaps failure to remember to take their medication, such as mestinon, at the proper intervals and thereby either underdose themselves, or overdose themselves, either of which can worsen the underlying weakness of their myasthenia gravis. The final point I try to discuss with my patients with MG who insist on using alcohol is not only the physical complications discussed above but also the social implications. This is best exemplified by one of my first myasthenic patients years ago during my residency who also had become a good friend. With her myasthenia gravis she had primarily bulbar weakness which produced marked dysarthric (slurred) speech and people always assumed incorrectly that she was intoxicated. This was compounded by the fact that she needed to carry small bottles of water with her whenever she needed to take her mestinon and this only heightened the suspicion that she was drinking "miniature" bottles of alcohol. More than once she was asked to leave department or grocery stores when she was trying to take her mestinon at its regularly scheduled time, particularly when the store managers or clerk noted her slurred speech. I mentioned this case simply to illustrate the fact that, unfortunately, society usually assumes slurred speech is secondary to the use of alcoholic beverages, particularly if the patient is known to use such. - John F. Aita, M.D. Midwest Clinic, Omaha, Neb. |