Myasthenia Gravis (my-us-THEE-nee-uh GRAY-vis) is characterized by weakness and rapid fatigue of any of the muscles under your voluntary control. It is caused by a breakdown in the normal communication between nerves and muscles. There is no cure for myasthenia gravis, but treatment can help relieve signs and symptoms, such as weakness of arm or leg muscles, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing and breathing.
Classification
The most widely accepted classification of myasthenia gravis is the Myasthenia Gravis Foundation of America Clinical Classification:
1. Class I: Any eye muscle weakness, possible ptosis, no other evidence of muscle weakness elsewhere
2. Class II: Eye muscle weakness of any severity, mild weakness of other muscles
a. Class IIa: Predominantly limb or axial muscles
b. Class IIb: Predominantly bulbar and/or respiratory muscles
3. Class III: Eye muscle weakness of any severity, moderate weakness of other muscles
a. Class IIIa: Predominantly limb or axial muscles
b. Class IIIb: Predominantly bulbar and/or respiratory muscles
4. Class IV: Eye muscle weakness of any severity, severe weakness of other muscles
a. Class IVa: Predominantly limb or axial muscles
b. Class IVb: Predominantly bulbar and/or respiratory muscles (Can also include feeding tube without intubation)
5. Class V: Intubation needed to maintain airway
Factors that can worsen Myasthenia Gravis
1. Fatigue
2. Illness Stress
3. Extreme heat
4. Some medications — such as beta blockers, quinidine gluconate, quinidine sulfate, quinine (Qualaquin), phenytoin (Dilantin), certain anesthetics and some antibiotics.
Signs and Symptoms
Muscle weakness caused by myasthenia gravis worsens as the affected muscle is used repeatedly. Because symptoms usually improve with rest, your muscle weakness may come and go. However, myasthenia gravis symptoms tend to progress over time, usually reaching their worst within a few years after the onset of the disease.
1. Eye muscles :
- Drooping of one or both eyelids (ptosis).
- Double vision (diplopia), which may be horizontal or vertical, and improves or resolves when one eye is closed.
2. Face and throat muscles :
- Altered speaking
- Difficulty swallowing
- Difficulty Breathing
- Problems chewing
- Limited facial expressions
3. Neck and limb muscles :
- weakness of neck, arms and legs
- The disorder usually affects arms more often than legs
- Difficulty Walking
Tests and Diagnosis
1. Neurological examination
2. Edrophonium test
3. Ice pack test
4. Blood analysis
5. Repetitive nerve stimulation
6. Single-fiber electromyography (EMG)
7. Imaging scans
8. Pulmonary function tests
Treatments
1. Cholinesterase inhibitors.
2. Corticosteroids
3. Immunosuppressants
4. Plasmapheresis (plaz-muh-fuh-REE-sis)
5. Intravenous immunoglobulin (IVIg)
6. Surgery :
- Thymectomy (removal of thymus gland)
a. Video-assisted thymectomy.
b. Robot-assisted thymectomy.
Classification
The most widely accepted classification of myasthenia gravis is the Myasthenia Gravis Foundation of America Clinical Classification:
1. Class I: Any eye muscle weakness, possible ptosis, no other evidence of muscle weakness elsewhere
2. Class II: Eye muscle weakness of any severity, mild weakness of other muscles
a. Class IIa: Predominantly limb or axial muscles
b. Class IIb: Predominantly bulbar and/or respiratory muscles
3. Class III: Eye muscle weakness of any severity, moderate weakness of other muscles
a. Class IIIa: Predominantly limb or axial muscles
b. Class IIIb: Predominantly bulbar and/or respiratory muscles
4. Class IV: Eye muscle weakness of any severity, severe weakness of other muscles
a. Class IVa: Predominantly limb or axial muscles
b. Class IVb: Predominantly bulbar and/or respiratory muscles (Can also include feeding tube without intubation)
5. Class V: Intubation needed to maintain airway
Factors that can worsen Myasthenia Gravis
1. Fatigue
2. Illness Stress
3. Extreme heat
4. Some medications — such as beta blockers, quinidine gluconate, quinidine sulfate, quinine (Qualaquin), phenytoin (Dilantin), certain anesthetics and some antibiotics.
Signs and Symptoms
Muscle weakness caused by myasthenia gravis worsens as the affected muscle is used repeatedly. Because symptoms usually improve with rest, your muscle weakness may come and go. However, myasthenia gravis symptoms tend to progress over time, usually reaching their worst within a few years after the onset of the disease.
1. Eye muscles :
- Drooping of one or both eyelids (ptosis).
- Double vision (diplopia), which may be horizontal or vertical, and improves or resolves when one eye is closed.
2. Face and throat muscles :
- Altered speaking
- Difficulty swallowing
- Difficulty Breathing
- Problems chewing
- Limited facial expressions
3. Neck and limb muscles :
- weakness of neck, arms and legs
- The disorder usually affects arms more often than legs
- Difficulty Walking
Tests and Diagnosis
1. Neurological examination
2. Edrophonium test
3. Ice pack test
4. Blood analysis
5. Repetitive nerve stimulation
6. Single-fiber electromyography (EMG)
7. Imaging scans
8. Pulmonary function tests
Treatments
1. Cholinesterase inhibitors.
2. Corticosteroids
3. Immunosuppressants
4. Plasmapheresis (plaz-muh-fuh-REE-sis)
5. Intravenous immunoglobulin (IVIg)
6. Surgery :
- Thymectomy (removal of thymus gland)
a. Video-assisted thymectomy.
b. Robot-assisted thymectomy.
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