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Myasthenia Gravis: Symptoms, Causes, diagnosis and treatment (1)

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Title: Myasthenia Gravis: Symptoms, Causes, diagnosis and treatment (1)


1
Myasthenia Gravis
2
Myasthenia Gravis
  • Myasthenia Gravis is a neuromuscular disorder
    primarily characterized by muscle weakness and
    muscle fatigue. Although the disorder usually
    becomes apparent during adulthood, symptom onset
    may occur at any age. The condition may be
    restricted to certain muscle groups, particularly
    those of the eyes (ocular myasthenia gravis), or
    may become more generalized (generalized
    myasthenia gravis), involving multiple muscle
    groups. Most individuals with myasthenia gravis
    develop weakness and drooping of the eyelids
    (ptosis) weakness of eye muscles, resulting in
    double vision (diplopia) and excessive muscle
    fatigue following activity.

3
What are the causes of Myasthenia Gravis?
  • Myasthenia Gravis is a neuromuscular
    disorder that is usually caused by an autoimmune
    problem. Autoimmune disorders occur when the
    immune system mistakenly attacks healthy tissue.
    In this condition, antibodies (proteins which
    normally attack foreign, harmful substances in
    the body) attack the neurotransmitter substance
    called acetylcholine, which is a crucial
    substance for nerve cell and muscle
    communication. This results in the muscle
    weakness that characterizes the condition. The
    exact cause of this autoimmune reaction is
    unclear to the doctors.

4
Who is at risk?
  • Myasthenia Gravis  is not inherited, and it is
    not contagious. It is not clear why people
    develop the disorder, although some researchers
    believe it could be from a genetic problem. For
    women, the disorder usually starts in their 20s
    and 30s for men, usually after age 50.

5
Symptoms
  • The main symptom of Myasthenia Gravis is
    weakness in the voluntary skeletal muscles, which
    are the muscles under your control. This weakness
    occurs with activity and can get better with
    rest. The failure of the muscles to contract
    normally occurs because they cannot respond to
    the nerve impulse. This is considered to be a
    blocked communication between nerve and muscle,
    and without the proper transmission of the
    impulse, weakness results. Weakness associated
    with MyastheniaGravis typically gets worse with
    more activity and improves with rest. Symptoms
    may include 
  • Trouble talking
  • Problems walking up stairs or lifting objects

6
Symptoms
Continue
  • Facial paralysis
  • Difficulty breathing because of muscle weakness
  • Difficulty swallowing or chewing
  • Fatigue
  • Hoarse voice
  • Drooping of eyelid
  • Double vision
  • Not everyone will have every symptom, and the
    degree of muscle weakness can change from day to
    day. The disease typically progresses over time
    if left untreated.

7
How Myasthenia Gravis is diagnosed?
  • Your doctor will perform a complete physical
    exam, as well as take a detailed history of
    symptoms. He or she will also do a neurological
    exam. This may consist of 
  • Checking your reflexes
  • Looking for muscle weakness
  • Checking for muscle tone
  • Making certain your eyes move properly
  • Testing sensation in different areas of your body
  • Seeing if you can perform certain movements, like
    touching your finger to your nose

8
How Myasthenia Gravis is diagnosed?
Continue
  • Other tests that can help your doctor diagnose
    the condition include Repetitive nerve
    stimulation test
  • Blood testing for antibodies associated with
    Myasthenia Gravis
  • Edrophonium (Tensilon) test a drug called
    Tensilon (or a placebo) is injected, and the
    patient is asked to perform muscle movements
    under doctor observation
  • Imaging of the chest, using CT scans or MRI, to
    rule out a tumour

9
Treatments
  • Common treatments for myasthenia gravis
    includeMedications such as Mestinon
    (pyridostigmine bromide) and Prostigmin
    (neostigmine bromide)
  • Corticosteroid medications such as prednisone
  • Medications that suppress the immune system, such
    as Imuran (azathioprine) and cyclosporine
  • Removal of the thymus gland (thymectomy), the
    main gland in the immune system
  • Plasma exchange (plasmapheresis), in which the
    person's blood plasma containing the abnormal
    antibodies is removed and fresh plasma is put
    back

10
Treatments
Continue
  • People with myasthenia gravis can in most cases
    lead full lives. Sometimes the muscle weakness
    resolves to the point of not being a problem
    (called spontaneous remission). For some people,
    the weakness is only in the eyelids. For others,
    the weakness progresses to a point and stays at
    that level. Rarely, and usually in the first two
    years of the disorder, the weakness might extend
    to the muscles that control breathing, and the
    person will have to be hospitalized. There is no
    cure for myasthenia gravis, but the treatments
    are usually effective in minimizing its problems.

11
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