Introduction

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Myasthenia gravis, It is a very rare term for many people in this world. We don’t know what myasthenia gravis is? basically, It is an autoimmune disease that impairs the connections between nerves and muscles. Although it doesn’t come under the categories of well-known disease but, it can be a severe one. It will not affect our liver and kidney or any vital organs but give a hard stroke to our immune system.

In the US, it is estimated that 5 in 80,000 have suffered from myasthenia gravis.

Definition of myasthenia gravis

It is a chronic neuromuscular as well as an autoimmune disease. In which some antibodies block the Ach receptors in the motor endplate that leads to various degrees of skeletal muscle weakness.

Clinical features

· painless muscle weakness (weakening of the voluntary muscles)

· insidious the onset of muscles weakness

· fluctuating muscle weakness

· fatigue increased with sustained effort or repetitive effort

· cranial muscles weakness (cranial muscles- the muscles that are associated with head and neck)

a) extraocular muscle weakness

i) It means the weakness most often starts from the muscles around the eyes.it leads to drooping of the eyelids which we called ptosis.

ii) it also causes some difficulty in coordinating eye movement, blurred or double a vision which is called diplopia.

b) impaired speaking(dysarthria); In this case, the speech of the person might sound soft or nasal, it mostly depends on which muscles have been affected.

c) difficulty in swallowing (dysphasia); The person having myasthenia gravis choked easily. If the person takes any pills and trying to swallow then it comes out of the nose.

d) change in facial expression; It means the facial muscles are getting weak. For example, your smile might look like a snarl.

e) impairment in voice quality(dysphonia)

· the the gait of the individual’s also affected by myasthenia gravis.

Is myasthenia gravis inherited?

· This the disease is neither inherited nor contagious, but in some cases, It seems that some infant born to the women who have myasthenia gravis shows the signs and symptoms of the disorder. It is also called transient neonatal myasthenia gravis.

· it is not completely inherited; It may occur if more than one member of the same family members having myasthenia gravis.

Diagnosis

· history collections

· physical examinations

· some investigations like; CT Scan, MRI

· some tests like edrophonium

· ice pack test

· ant musk antibody test

· blood analysis

· repetitive nerve stimulation

· single fiber electromyography

· pulmonary function test

Neurological examinations

There are also some neurological examination tests that we can do for proper identifications of the disease.

· reflexes

· muscle tone

· senses or touch

· coordination

· balance

· muscle strength

Treatment

Here, is some pharmacological treatment that the a person needs to regain muscle strength.

· anticholinesterase drugs like pyridostigmine and neostigmine 15 mg orally 6 hourly.

· prednisolone 30-60 mg /day induces remission in about 80% of advanced cases.

· some immunosuppressive drugs like azathioprine, cyclosporine, corticosteroids which reduce the production of antibodies.

· IV immunoglobulin which temporarily modifies the immune system and provided body with normal antibodies from donated blood.

· plasma phoresies (it removes the abnormal antibodies from the immune system). it is often a short-lived improvement in myasthenia crisis.

Surgical treatment

Thymectomy

Thymectomy is a generalized surgical procedure that is mainly advised for the person who has insidious as fluctuating muscle weakness with a thymoma. Thymectomy is effective in the majority of cases.