A 66-Year-Old Man Comes to the Office with Diplopia That

A 66-year-old man comes to the office with diplopia that progressively worsens toward the end of the day.  The patient has no shortness of breath, trouble swallowing, or generalized weakness.  He is currently receiving low-dose pyridostigmine for treatment of his condition and claims good compliance without significant side effects.  Physical examination reveals fatigable asymmetric ptosis and binocular horizontal diplopia.  Infusion of edrophonium elicits a significant improvement in his symptoms.  Which of the following is the best next step in management of this patient?

A) Add atropine
B) Administer pralidoxime
C) Change long-term therapy to edrophonium
D) Increase pyridostigmine dosage
E) Stop pyridostigmine temporarily

Correct Answer:

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