An improvement in muscle strength upon injection suggests myasthenic crisis. If there is no improvement or there is actual deterioration in condition with injection, then the patient is probably in cholinergic crisis. Is a rapidly progressing, degenerative, fatal disease. It is characterized by destruction of motor cells in the anterior grey horns of the spinal cord. Sensory changes are not part of the disease.
Classic pattern begins with weakness, atrophy, fasciculations of the muscles of hands and arms.
Later this converts to spastic paralysis of the limbs. Etiology is unknown.