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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)

The vast surface area, permeability, and vascularization of the nasal mucosa contribute to high systemic drug absorption, resulting in a rapid onset of action and enhanced bioavailability compared to oral medications

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FASEB J 33:43884403 Babu GN, Kumar A, Chandra R et al (2008) Oxidant-antioxidant imbalance in the erythrocytes of sporadic amyotrophic lateral sclerosis patients correlates with the progression of disease