Myasthenia Gravis

Mike Willcut

Myasthenia What?
My-as-thee-nee-ah Grr-a-vis Auto immune disease Hereditary genetic mutation Causes muscle weakness

Where have I heard that?

Contraindication for
Versed Fentanyl Precaution for sux

Pathophysiology
Auto Immune
Antibodies attack Ach Receptors Decreased cell excitement o Electrical threshold o No action potential o Weakness

Cell with MG

This might be on the Quiz

How does MG affect the body?

A Blocks motor receptors causing weakness

B - Increases stimulus threshold C - Decreases stimulus threshold D - Reduces amount of Ach released causing weakness

Classification
1: Eye muscle weakness (EMW) 2: EMW and other mild muscle weakness
a. Predominantly limb or axial muscles b. Predominantly bulbar or respiratory muscles

3: EMW and other moderate weakness

a. Predominantly limb or axial muscles b. Predominantly bulbar or respiratory muscles

4: EMW and other severe weakness

a. Predominantly limb or axial muscles b. Predominantly bulbar or respiratory muscles

5: Intubation needed to maintain airway

Whos at Risk
Females 20-40 Males 60-80 Those with another AI Disease Penicillamine users (rheumatoid med) Enlarged Thymus or thymoma 20 in 100,000 or 2 in 1million (discrepancy)

Diseases Typically Associated With MG

Diabetes Type 1 Rheumatoid Arthritis Lupus Demyelination CNS Disease Other Auto immune diseases

What will we see?

Hallmark S/S
Eye lid drooping (ptosis) Impaired speech (dysarthria) Difficulty Swallowing (dysphagia) Double Vision (dipoplia) Easily fatigued, quick recovery with rest Waddling gait

Physical Exam
Test for muscle fatigueability
Look up and to the side for 30 sec If supine, look at feet for 1min Arms stretched forward for 1min 10 deep knee bends or squats

Look for ptosis and ask about diplopia

Myasthenia Crisis
Requires immediate assistance
Shortness of breath Extreme muscle weakness General fatigueablility Respiratory muscle paralysis

MG in Pregnancy
Many mothers get worse 1st trimester and better 2nd and 3rd trimester. Up to 10% of infants born to mothers with MG will have Transient Neonatal Myasthenia.
Weak cry, poor muscle tone, difficulty breathing etc

Interventions
Depending on severity
RSI Supportive care

Triggers
May be triggered by:
Infection Stress Fever Adverse reaction to medications

Hospital Tests
Blood tests
Tests for specific antibodies Only 50% accurate

CT Chest X-Ray Endrophonium Test

IV injection of acetylcholinesterase inhibitor

Treatment
Actylcholinesterase inhibitors Corticosteroids immunosuppressants Thymectomy Plasmapheresis
Like dialysis

Naturopathic Treatment
Counseling sessions
Eliminate stress and poor self image

Diet and nutrition Moshe Daniel ND

Prognosis
Very Good!
Most get relief from simple treatment Some go into remission Only 2-3% mortality rate

Fun Facts
Radix family of Chinese herbs can help with symptoms. Gravitax, a combination of iron, aloe vera, and apiaceae First discription of MG in 1672 1935 Prostigmin Demonstration for MG

Sources
Daniel, Moshe. "The Treatment and Philosophy of Healing For Myasthenia Gravis ." 29 Sep 2007 12 Dec 2008 <http://www.thelastfourbooks.com/myasthenia_grav is_alternative_medicine_cure.html>.
Howard, James, F. "About Myasthenia Gravis." For Health Care Professionals 30 Sep 2006 12 Dec 2008 <http://www.myasthenia.org/amg_whatismg.cfm>. "Myasthenia gravis." Wikipedia. 2008. Wikimedia Foundation Inc. 12 Dec 2008 <http://en.wikipedia.org/wiki/Myasthenia_gravis> . "What causes Myasthenia Gravis." Myasthenia Gravis Fact Sheet 25 Jul 2008 12 Dec 2008 <http://www.ninds.nih.gov/disorders/myasthenia_g

ravis/detail_myasthenia_gravis.htm>.

Thats All