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Caffeine has been shown to be a cholinesterase inhibitor, like Mestinon. They inhibit acetylcholinesterase,
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Thanks for this Annie. I didn't know that. It just shows how complex the human body is and how many effects pharmacological agents can have, apart from their well-known mode of action.
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Calcium may be more at play here than ACh.
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The known mode of action of caffeine is inhibition of an enzyme-phosphodiesterase. This leads to increased levels of cAMP, which is a very important secondary messenger, in many cells. But, it also has a direct effect on the ryanodine receptor.
http://www.ncbi.nlm.nih.gov/pmc/arti...00432-0219.pdf
And possibly other effects we are not yet aware of?
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Oh, and about that not noticing thing. Are you SURE you didn't? Were there any physical activities you couldn't do as a child? Any that you did less of than others? Did you nap in the afternoons (past the time you "took" naps)? I had so many clues growing up that I simply ignored. I thought I just had to try harder.
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I agree with that. There is adult onset CMS. I believe that it is there from birth, but very mild. There is a normal distribution of strength and endurance in the population, so it can be seen as the bottom of normal, even though it is abnormal.
To complicate matters, it is quite possible to have both-a mild genetic abnormality, combined with an autoimmune MG.
Also, there is more and more evidence showing that MuSK (and possibly other types) autoimmune MG, is caused by a different mechanism than "classical MG". This is why the response to mestinon is less clear and optimal, but could also be that the response to other agents (such as ventolin, ephedrine etc.) would be better.
Ephedrine was in fact the first treatment for MG. It was found incidentally by a physician (Harriet Edgewood) who had MG, and was given Ephedrine for some other minor medical problem. She noticed that it made her MG much better and shared this with her physicians (who actually listened to her and were ready to check it out).
http://qjmed.oxfordjournals.org/content/5/1/21.full.pdf
I wish physicians were as meticulous today, as those who have written this paper. I also wish that medical journals and the medical community would appreciate more the importance of a single case study.