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Myasthenia Gravis

Myasthenia Gravis. Mike Willcut. Myasthenia What?. My-as-thee-nee-ah Grr-a-vis Auto immune disease Hereditary genetic mutation Causes muscle weakness. Where have I heard that?. Contraindication for Versed Fentanyl Precaution for sux. Pathophysiology. Auto Immune

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Myasthenia Gravis

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  1. Myasthenia Gravis Mike Willcut

  2. Myasthenia What? • My-as-thee-nee-ah Grr-a-vis • Auto immune disease • Hereditary genetic mutation • Causes muscle weakness

  3. Where have I heard that? • Contraindication for • Versed • Fentanyl Precaution for sux

  4. Pathophysiology • Auto Immune • Antibodies attack Ach Receptors Decreased cell excitement • Electrical threshold • No action potential • Weakness

  5. Cell with MG

  6. This might be on the Quiz How does MG affect the body? • A – Blocks motor receptors causing weakness • B - Increases stimulus threshold • C - Decreases stimulus threshold • D - Reduces amount of Ach released causing weakness

  7. Classification • 1: Eye muscle weakness (EMW) • 2: EMW and other mild muscle weakness • Predominantly limb or axial muscles • Predominantly bulbar or respiratory muscles • 3: EMW and other moderate weakness • Predominantly limb or axial muscles • Predominantly bulbar or respiratory muscles • 4: EMW and other severe weakness • Predominantly limb or axial muscles • Predominantly bulbar or respiratory muscles • 5: Intubation needed to maintain airway

  8. Who’s at Risk • Females 20-40 • Males 60-80 • Those with another AI Disease • Penicillamine users (rheumatoid med) • Enlarged Thymus or thymoma • 20 in 100,000 or 2 in 1million (discrepancy)

  9. Diseases Typically Associated With MG • Diabetes Type 1 • Rheumatoid Arthritis • Lupus • Demyelination CNS Disease • Other Auto immune diseases

  10. What will we see? • Hallmark S/S • Eye lid drooping (ptosis) • Impaired speech (dysarthria) • Difficulty Swallowing (dysphagia) • Double Vision (dipoplia) • Easily fatigued, quick recovery with rest • Waddling gait

  11. Physical Exam • Test for muscle fatigueability • Look up and to the side for 30 sec • If supine, look at feet for 1min • Arms stretched forward for 1min • 10 deep knee bends or squats Look for ptosis and ask about diplopia

  12. Myasthenia Crisis Requires immediate assistance • Shortness of breath • Extreme muscle weakness • General fatigueablility • Respiratory muscle paralysis

  13. MG in Pregnancy • Many mothers get worse 1st trimester and better 2nd and 3rd trimester. • Up to 10% of infants born to mothers with MG will have Transient Neonatal Myasthenia. • Weak cry, poor muscle tone, difficulty breathing etc…

  14. Interventions • Depending on severity • RSI • Supportive care

  15. Triggers • May be triggered by: • Infection • Stress • Fever • Adverse reaction to medications

  16. Hospital Tests • Blood tests • Tests for specific antibodies • Only 50% accurate • CT • Chest X-Ray • Endrophonium Test • IV injection of acetylcholinesterase inhibitor

  17. Treatment • Actylcholinesterase inhibitors • Corticosteroids immunosuppressants • Thymectomy • Plasmapheresis • Like dialysis

  18. Counseling sessions Eliminate stress and poor self image Diet and nutrition Moshe Daniel ND Naturopathic Treatment

  19. Prognosis • Very Good! • Most get relief from simple treatment • Some go into remission Only 2-3% mortality rate

  20. Fun Facts • Radix family of Chinese herbs can help with symptoms. • Gravitax, a combination of iron, aloe vera, and apiaceae • First discription of MG in 1672 • 1935 Prostigmin Demonstration for MG

  21. Sources • Daniel, Moshe. "The Treatment and Philosophy of Healing For Myasthenia Gravis ." 29 Sep 2007 12 Dec 2008 <http://www.thelastfourbooks.com/myasthenia_gravis_alternative_medicine_cure.html>. • Howard, James, F. "About Myasthenia Gravis." For Health Care Professionals 30 Sep 2006 12 Dec 2008 <http://www.myasthenia.org/amg_whatismg.cfm>. • "Myasthenia gravis." Wikipedia. 2008. Wikimedia Foundation Inc. 12 Dec 2008 <http://en.wikipedia.org/wiki/Myasthenia_gravis>. • "What causes Myasthenia Gravis." Myasthenia Gravis Fact Sheet 25 Jul 2008 12 Dec 2008 <http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm>.

  22. That’s All

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