Myasthenia Gravis . ppt
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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
Who’s 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>.
That’s All