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The spine, for example, is not a collection of independent segmentsit is a functional unit in which every level influences the levels above and below it, in which joint degeneration at one level creates compensatory stress at adjacent levels, in which muscle imbalances create asymmetric loading that accelerates degeneration across multiple structures simultaneously, and in which the pain experienced by the patient reflects the cumulative dysfunction of the entire system, not the pathology of a single MRI finding

Additionally, there is evidence that even without extreme stress, pyridostigmine may exhibit at least partial BBB permeability in highly specific regions like the fourth ventricle and brainstem, which house central respiratory centers (Dunn et al, 1997)

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