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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
 Antibodies attack Ach Receptors
Decreased cell excitement
o Electrical threshold
o No action potential
o Weakness
Cell with MG
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
Classification


1: Eye muscle weakness (EMW)
2: EMW and other mild muscle weakness
a. Predominantly limb or axial muscles
b. Predominantly bulbar or respiratory muscles

3: EMW and other moderate weakness
a. Predominantly limb or axial muscles
b. Predominantly bulbar or respiratory muscles

4: EMW and other severe weakness
a. Predominantly limb or axial muscles
b. Predominantly bulbar or respiratory muscles

5: Intubation needed to maintain airway
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)
Diseases Typically
Associated With MG
• Diabetes Type 1
 Rheumatoid Arthritis
 Lupus
 Demyelination CNS Disease
 Other Auto immune diseases
What will we see?
 Hallmark S/S
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Eye lid drooping (ptosis)
Impaired speech (dysarthria)
Difficulty Swallowing (dysphagia)
Double Vision (dipoplia)
Easily fatigued, quick recovery with rest
Waddling gait
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
Myasthenia Crisis
Requires immediate assistance
•
•
•
•
Shortness of breath
Extreme muscle weakness
General fatigueablility
Respiratory muscle paralysis
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…
Interventions
 Depending on severity
 RSI
 Supportive care
Triggers
 May be triggered by:
 Infection
 Stress
 Fever
 Adverse reaction to medications
Hospital Tests
 Blood tests
 Tests for specific antibodies
 Only 50% accurate
 CT
 Chest X-Ray
 Endrophonium Test
 IV injection of acetylcholinesterase inhibitor
Treatment
 Actylcholinesterase inhibitors
 Corticosteroids
immunosuppressants
 Thymectomy
 Plasmapheresis
 Like dialysis
Naturopathic Treatment
 Counseling
sessions
 Eliminate stress
and poor self
image
 Diet and nutrition
 Moshe Daniel ND
Prognosis
 Very Good!
 Most get relief from simple treatment
 Some go into remission
Only 2-3% mortality rate
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
Sources

Daniel, Moshe. "The Treatment and Philosophy of
Healing For Myasthenia Gravis ." 29 Sep 2007 12
Dec 2008
<http://www.thelastfourbooks.com/myasthenia_grav
is_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_g
ravis/detail_myasthenia_gravis.htm>.
That’s All