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1、Myasthenia GravisMyasthenia GravisMike WillcutMyasthenia What?wMy-as-thee-nee-ah Grr-a-viswAuto immune diseasewHereditary genetic mutationwCauses muscle weaknessWhere have I heard that?wContraindication forwVersedwFentanylPrecaution for suxPathophysiologywAuto ImmunewAntibodies attack Ach ReceptorsD
2、ecreased cell excitementoElectrical thresholdoNo action potentialoWeaknessCell with MGThis might be on the QuizHow does MG affect the body?wA Blocks motor receptors causing weaknesswB - Increases stimulus thresholdwC - Decreases stimulus thresholdwD - Reduces amount of Ach released causing weaknessC
3、lassificationw1: Eye muscle weakness (EMW)w2: EMW and other mild muscle weaknessa.Predominantly limb or axial musclesb.Predominantly bulbar or respiratory musclesw3: EMW and other moderate weaknessa.Predominantly limb or axial musclesb.Predominantly bulbar or respiratory musclesw4: EMW and other sev
4、ere weaknessa.Predominantly limb or axial musclesb.Predominantly bulbar or respiratory musclesw5: Intubation needed to maintain airwayWhos at RiskwFemales 20-40wMales 60-80wThose with another AI DiseasewPenicillamine users (rheumatoid med)wEnlarged Thymus or thymomaw20 in 100,000 or 2 in 1million (d
5、iscrepancy)Diseases Typically Associated With MGDiabetes Type 1wRheumatoid ArthritiswLupuswDemyelination CNS DiseasewOther Auto immune diseasesWhat will we see?wHallmark S/SwEye lid drooping (ptosis)wImpaired speech (dysarthria) wDifficulty Swallowing (dysphagia)wDouble Vision (dipoplia) wEasily fat
6、igued, quick recovery with restwWaddling gaitPhysical ExamwTest for muscle fatigueabilitywLook up and to the side for 30 secwIf supine, look at feet for 1minwArms stretched forward for 1minw10 deep knee bends or squats Look for ptosis and ask about diplopiaMyasthenia CrisisRequires immediate assista
7、nceShortness of breathExtreme muscle weaknessGeneral fatigueablilityRespiratory muscle paralysisMG in PregnancywMany mothers get worse 1st trimester and better 2nd and 3rd trimester.wUp to 10% of infants born to mothers with MG will have Transient Neonatal Myasthenia.wWeak cry, poor muscle tone, dif
8、ficulty breathing etcInterventionswDepending on severitywRSIwSupportive careTriggerswMay be triggered by:wInfectionwStresswFeverwAdverse reaction to medicationsHospital TestswBlood testswTests for specific antibodieswOnly 50% accuratewCTwChest X-RaywEndrophonium TestwIV injection of acetylcholineste
9、rase inhibitorTreatmentwActylcholinesterase inhibitorswCorticosteroids immunosuppressantswThymectomywPlasmapheresiswLike dialysisNaturopathic TreatmentwCounseling sessionswEliminate stress and poor self image wDiet and nutritionwMoshe Daniel NDPrognosiswVery Good!wMost get relief from simple treatme
10、ntwSome go into remissionOnly 2-3% mortality rateFun FactswRadix family of Chinese herbs can help with symptoms.wGravitax, a combination of iron, aloe vera, and apiaceaewFirst discription of MG in 1672w1935 Prostigmin Demonstration for MGSourceswDaniel, Moshe. The Treatment and Philosophy of Healing
11、 For Myasthenia Gravis . 29 Sep 2007 12 Dec 2021 . wHoward, James, F. About Myasthenia Gravis. For Health Care Professionals 30 Sep 2006 12 Dec 2021 . wMyasthenia gravis. Wikipedia. 2021. Wikimedia Foundation Inc. 12 Dec 2021 . wWhat causes Myasthenia Gravis. Myasthenia Gravis Fact Sheet 25 Jul 2021 12 Dec 2021 . Thats All
