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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

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myasthenia gravis

Myasthenia Gravis

Mike Willcut

myasthenia what
Myasthenia What?
  • My-as-thee-nee-ah Grr-a-vis
  • Auto immune disease
  • Hereditary genetic mutation
  • Causes muscle weakness
where have i heard that
Where have I heard that?
  • Contraindication for
    • Versed
    • Fentanyl

Precaution for sux

pathophysiology
Pathophysiology
  • Auto Immune
    • Antibodies attack Ach Receptors

Decreased cell excitement

    • Electrical threshold
    • No action potential
    • Weakness
this might be on the quiz
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
Classification
  • 1: Eye muscle weakness (EMW)
  • 2: EMW and other mild muscle weakness
    • Predominantly limb or axial muscles
    • Predominantly bulbar or respiratory muscles
  • 3: EMW and other moderate weakness
    • Predominantly limb or axial muscles
    • Predominantly bulbar or respiratory muscles
  • 4: EMW and other severe weakness
    • Predominantly limb or axial muscles
    • Predominantly bulbar or respiratory muscles
  • 5: Intubation needed to maintain airway
who s at risk
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
Diseases Typically Associated With MG
  • Diabetes Type 1
  • Rheumatoid Arthritis
  • Lupus
  • Demyelination CNS Disease
  • Other Auto immune diseases
what will we see
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
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
Myasthenia Crisis

Requires immediate assistance

  • Shortness of breath
  • Extreme muscle weakness
  • General fatigueablility
  • Respiratory muscle paralysis
mg in pregnancy
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
Interventions
  • Depending on severity
    • RSI
    • Supportive care
triggers
Triggers
  • May be triggered by:
    • Infection
    • Stress
    • Fever
    • Adverse reaction to medications
hospital tests
Hospital Tests
  • Blood tests
    • Tests for specific antibodies
    • Only 50% accurate
  • CT
  • Chest X-Ray
  • Endrophonium Test
    • IV injection of acetylcholinesterase inhibitor
treatment
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

Naturopathic Treatment
prognosis
Prognosis
  • Very Good!
    • Most get relief from simple treatment
    • Some go into remission

Only 2-3% mortality rate

fun facts
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
Sources
  • Daniel, Moshe. "The Treatment and Philosophy of Healing For Myasthenia Gravis ." 29 Sep 2007 12 Dec 2008 <http://www.thelastfourbooks.com/myasthenia_gravis_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_gravis/detail_myasthenia_gravis.htm>.
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