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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>.