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Myasthenia Gravis

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Myasthenia Gravis Disease of the neuromuscular junction characterized by fluctuating weakness of certain skeletal muscle groups. Myasthenia Gravis(MG) Acetycholine ... – PowerPoint PPT presentation

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Title: Myasthenia Gravis


1
Myasthenia Gravis
  • Disease of the neuromuscular junction
    characterized by fluctuating weakness of certain
    skeletal muscle groups.

2
Myasthenia Gravis(MG)
  • Acetycholine (ACh) is an important
    neurotransmitter that stimulates muscle tissue to
    contract.
  • MG is an autoimmune disease in which antibodies
    are formed against ACh and a reduction in ACh
    receptor sites at the neuromuscular junction.

3

4
Pathophysiology
  • Loss of muscle strength.
  • There is no single cause identified, however,
    thymic tumors and viral infections have been
    found in a certain number of patients.

5
Clinical manifestations
  • Primary s/s easy fatigability of skeletal muscle
    during activity.
  • Muscles involved eyes and eyelids, chewing,
    swallowing, speaking, and breathing.
  • Fluctuating weakness usually strong in the a.m.,
    progressively weaker with activity.

6
Clinical Manifestations
  • 90 of patients have eye involvement
  • Facial mobility may be impaired
  • Muscles of limb and trunk less often affected.
  • No sensory or reflex loss muscle atrophy is
    rare.

7
Clinical manifestations
  • Variable course
  • May be precipitated by emotional stress,
    pregnancy, menses, secondary illness, trauma,
    temperature extremes, hypokalemia, ingestion of
    drugs with neuromuscular blocking agents, surgery.

8
Complications
  • Aspiration, respiratory insufficiency, and
    respiratory infection
  • Acute exacerbation called myasthenic crisis.
  • The opposite of this is a cholinergic crisis and
    results from overdose of cholinergic drugs.

9
Diagnostic studies
  • Assessment
  • Have pt look up for 2-3 minutes if MG, patient
    will have increased droop of eyelids.
  • EMG may show muscle fatigue
  • Tensilon test- in MG reveal improved muscle
    contractility after IV anticholinesterase agent
    edrophonium chloride (tensilon)
  • Also diagnosis cholinergic crisis- muscle
    weakness gets worse
  • Keep atropine on hand to counteract effects of
    tensilon

10
Therapeutic management
  • Anticholinesterase inhibitors- prevents
    anticholinestersase from breaking down ACh helps
    neurotransmission. Monitor dose!
  • Mestinon, Prostigmine
  • Corticosteroids- decrease immune response
  • Prednisone
  • Plasmapheresis- removes ACh antibodies and
    short-term improvement.
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