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 muscle weakness occur? In the morning? In the evening? After physical exertion?
- Where exactly does the muscle weakness occur?
- Do you feel like you lack strength?
- Can you climb stairs without any problems?
- Are you quickly exhausted after exercise?
- Do you have shortness of breath* during/after physical exertion?
- Has there been any change in your eyes?
- Drooping of the eyelid?
- Do you see double vision?
- Do you suffer from difficulty chewing, drinking, swallowing or speaking?
- Have you noticed any paralysis? If so, how long have these existed and where exactly are they localized?
- Are your trunk and spinal muscles affected?
- What other symptoms have you noticed, such as.
- Balance problems?
- Memory disorders?
- Sensory disturbances?
- Have you noticed that the symptoms worsen in certain situations (eg, stress, mental stress)?
Vegetative anamnesis including nutritional anamnesis.
- Have you lost weight unintentionally?
Self-history
- Previous diseases (neurological diseases)
- Operations
- Allergies
- Pregnancies
Medication history
- D-penicillamine, chloroquine (antimalarials) – may cause myasthenic syndromes.
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 Tobramycin.
- Macrolides – e.g., erythromycin
- Ketolides – telithromycin/Ketek
- Lincomycins
- Polymyxins
- Gyrase inhibitors – levofloxacin, ciprofloxacin, prulifloxacin.
- Sulfonamides
- Tetracyclines
- Penicillins – only in particularly high dosage.
- Antidepressants – amitriptyline-type substances.
- Anticonvulsants – benzodiazepines, carbamazepine, diphenylhydantoin, ethosuximide, gabapentin.
- Antimalarials – quinine, chloroquine and analogs.
- Antirheumatic drugs – chloroquine, etanercept
- Beta-blockers – oxprenolol, pindolol, practolol, propranolol, timolol – also used topically as eye drops.
- Botulinum toxin
- Calcium antagonists – verapamil, diltiazem, nifedipine and relatives.
- Diuretics – acetazolamide, benzothiadiazines, loop diuretics.
- Glucocorticoids (clinically relevant worsening is rare at intermediate doses or insipid dosing)
- Interferons – interferon-alpha (isolated cases).
- Lithium
- Local anesthetics – procaine (ester type), the amide type substances used today are not problematic.
- Magnesium – high doses as laxatives (laxatives).
- Monoclonal antibodies: durvalumab (rare).
- Muscle relaxants
- Curare derivatives – due to increased sensitivity, initially (starting) choose 10-50% of normal dosage
- Succhinylcholine – Should generally not be used because it cannot be antagonized with pyridostigmine!
- Narcotics
- Psychotropic drugs – chlorpromazine, promazine and relatives, all benzodiazepines and structural relatives such as zolpidem, zopiclone
- Statins – several reports of findings on various cholesterol-lowering drugs.
- Analgesics
- Thyroid disease
- Mental stress
- Vibrations
* If this question has been answered with “Yes”, an immediate visit to the doctor is required!(data without guarantee)
