Write a short note on the clinical presentation and management of Myasthenia Gravis
MG is an autoimmune condition characterised by progressive muscle fatigue.
- The most common and typical complains are;
- Blurry vision, diplopia or drooping of eyelids as the day progesses or while watching TV for a long time
- In abillity to complete meals due to fatigue of mastication muscles
- Loss of facial expressions, especially smile
- Altered voice when the patient speaks for a longer time, this can also be tested by asking the patient to count from 1 to 40
- Difficulty swallowing
- Performing simple tasks using hands
- Waddling gait, when the legs are involved
- All these symptoms improve with rest*
- If the patient is young, then it is mostly a female who has an underlying autoimmune pathology, which becomes worse, when she gets pregnant.
- If the patient is old, then it is mostly a male who has an underlying thymoma as the cause of Myasthenia gravis
- Tensilon test: the symptoms improve within 2-5 mins of administration of this drug. However, the improvement is not as drastic as described in text books.
- Afternately, ice packs can be placed on the drooping eyelids for 2 mins and any improvement can be noted
- Blood tests show presence of anti acetylcholine receptor antibodies
- Repeated nerve stimulation will show muscle fatigue quicker than in normal individuals
- Electromyography studies
- Chest CT scan for thymoma
- Symptomatic treatment with: Cholinesterase (pyridostigmine or neostigmine)
- Prednisone for relapses or non responsive to cholinesterase treatment
- Ventilatory support in case of breathing muscles involvement
- IV immunoglobulins
AUTHOR: Dr. Waiz Wasey
- Conrad Fischer; Sonia Reichert. Neurology: Myasthenia Gravis. Master the Boards USMLE Step 3. New York (USA): Kaplan; 2012: 225.
- Murray Longmore et al. Neurology: Myasthenia Gravis. Oxford Handbook of Clinical Medicine. New York (USA): Oxford University Press; 2010: 516.