The following symptoms and complaints may indicate myasthenia gravis: Leading symptoms Exercise-dependent muscle weakness after muscle activity; exhaustion occurs rapidly after a few repetitive movements Secondary symptoms Ptosis (drooping of the eyelid; “bedroom gaze”). Diplopia (double vision) Often weakness of the muscles of the extremities, usually the arms are affected more than the legs in … Myasthenia Gravis: Symptoms, Complaints, Signs
Pathogenesis (disease development) Myasthenia gravis is one of the autoimmune diseases. In this case, antibodies are directed against the body’s own structures, in this case against structures of the postsynaptic (located behind the junction (synapse)) membrane in the area of the motor end plate of the striated (voluntarily movable) muscles (skeletal muscles). In about 85% … Myasthenia Gravis: Causes
General measures Review of permanent medication due topossible effect on the existing disease (symptom exacerbation!). Avoidance of psychosocial stress (symptom exacerbation): Bullying Mental conflicts Social isolation Stress Conventional non-surgical therapy methods If necessary, logopedic therapy, because speech is disturbed by impairment of the tongue, mouth, and/or palate muscles and by speech-dependent dyspnea (shortness of breath). … Myasthenia Gravis: Therapy
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count Electrolytes – calcium, magnesium, sodium, potassium, phosphates, chloride. Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Liver parameters – alanine aminotransferase (GPT), aspartate aminotransferase (GOT). Fasting glucose (fasting blood glucose), if necessary oral glucose tolerance test (oGTT). Thyroid … Myasthenia Gravis: Test and Diagnosis
Therapy goals Stabilization of quality of life Improvement and maintenance of independence in terms of mobility, participation in social life and independent care. Therapy recommendations To reduce the autoimmune response – immunosuppression must be maintained for several years, often for life 1st-line agents: immunosuppressants – the only approved nonsteroidal immunosuppressant in the setting of myasthenia … Myasthenia Gravis: Drug Therapy
Obligatory medical device diagnostics. Electrophysiology – low-frequency serial stimulation (3 Hz) of the accessorius or facial nerve. A pathologic (pathological) result is present when the 5th amplitude is at least 10% smaller than the 1st amplitude (= decrement); from the 6th amplitude onward, a slight rebound follows (= increment) Is found in a maximum of … Myasthenia Gravis: Diagnostic Tests
Thymectomy (removal of the thymus/bris) can have a positive effect on the course of the disease. In young patients, this may result in a decrease in symptoms. Then, even discontinuation of immunosuppressive drugs is possible. Indications: Patients with generalized (affecting the entire body) myasthenia without thymoma. Patients between 15-50 years of age, insofar as thymectomy … Myasthenia Gravis: Surgical Therapy
Prevention of myasthenia gravis is not possible. Existing myasthenia gravis may be worsened by the following factors: Inflammation Fever Heat Hormonal fluctuations – during menstruation. Infections Physical stresses Medications (A claim to completeness does not exist!) Analgesics Flupirtine Morphine preparations Antiarrhythmic drugs – quinidine, ajmaline, mexitil, procainamide. Antibiotics Aminoglycosides – v. a. Streptomycin, Neomycin, less … Myasthenia Gravis: Prevention
Medical history (history of illness) represents an important component in the diagnosis of myasthenia gravis. Family history Are there any hereditary diseases in your family? Are there any diseases in your family that are common? Social anamnesis Current medical history/systemic history (somatic and psychological complaints). How long has this symptomatology been present? When does the … Myasthenia Gravis: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Congenital (congenital) myasthenic syndrome. Endocrine, nutritional, and metabolic diseases (E00-E90). Endocrine orbitopathy (EO) – disease in which there is exophthalmos (protrusion of the eyeballs). Infectious and parasitic diseases (A00-B99). Botulism – poisoning with paralytic symptoms caused by botulinum toxin. Musculoskeletal system and connective tissue (M00-M99). Dermatomyositis (DM) – … Myasthenia Gravis: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by myasthenia gravis: Musculoskeletal system and connective tissue (M00-M99). Cholinergic crisis – muscle weakness resulting from excessive doses of cholinesterase inhibitors; signs include increased tearing and salivation, diarrhea (diarrhea), and tachycardia (heartbeat too fast: >100 beats per minute); mortality risk (risk … Myasthenia Gravis: Complications
The simplest subdivision of myasthenia gravis is as follows: Ocular myasthenia – only the external eye muscles are affected. Generalized myasthenia – involvement of facial, pharyngeal, cervical/neck, and skeletal muscles; mild/medium/severe expression possible Paraneoplastic myasthenia – in case of thymoma (tumor originating from thymic tissue). Congenital (congenital) myasthenia (rare) – autosomal recessive inherited disorder, with … Myasthenia Gravis: Classification
