Myasthenia Gravis：重症肌无力

1、Myasthenia GravisMike WillcutMyasthenia What?My-as-thee-nee-ah Grr-a-visAuto immune diseaseHereditary genetic mutationCauses muscle weaknessWhere have I heard that?Contraindication forVersedFentanylPrecaution for suxPathophysiologyAuto ImmuneAntibodies attack Ach ReceptorsDecreased cell excitementEl

2、ectrical thresholdNo action potentialWeaknessCell with MGThis might be on the QuizHow does MG affect the body?A Blocks motor receptors causing weaknessB - Increases stimulus thresholdC - Decreases stimulus thresholdD - Reduces amount of Ach released causing weaknessClassification1: Eye muscle weakne

3、ss (EMW)2: EMW and other mild muscle weaknessPredominantly limb or axial musclesPredominantly bulbar or respiratory muscles3: EMW and other moderate weaknessPredominantly limb or axial musclesPredominantly bulbar or respiratory muscles4: EMW and other severe weaknessPredominantly limb or axial muscl

4、esPredominantly bulbar or respiratory muscles5: Intubation needed to maintain airwayWhos at RiskFemales 20-40Males 60-80Those with another AI DiseasePenicillamine users (rheumatoid med)Enlarged Thymus or thymoma20 in 100,000 or 2 in 1million (discrepancy)Diseases Typically Associated With MGDiabetes

5、 Type 1Rheumatoid ArthritisLupusDemyelination CNS DiseaseOther Auto immune diseasesWhat will we see?Hallmark S/SEye lid drooping (ptosis)Impaired speech (dysarthria) Difficulty Swallowing (dysphagia)Double Vision (dipoplia) Easily fatigued, quick recovery with restWaddling gaitPhysical ExamTest for

6、muscle fatigueabilityLook up and to the side for 30 secIf supine, look at feet for 1minArms stretched forward for 1min10 deep knee bends or squats Look for ptosis and ask about diplopiaMyasthenia CrisisRequires immediate assistanceShortness of breathExtreme muscle weaknessGeneral fatigueablilityResp

7、iratory muscle paralysisMG in PregnancyMany 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 etcInterventionsDepending on severityRSISupportive careTr

8、iggersMay be triggered by:InfectionStressFeverAdverse reaction to medicationsHospital TestsBlood testsTests for specific antibodiesOnly 50% accurateCTChest X-RayEndrophonium TestIV injection of acetylcholinesterase inhibitorTreatmentActylcholinesterase inhibitorsCorticosteroids immunosuppressantsThy

9、mectomyPlasmapheresisLike dialysisNaturopathic TreatmentCounseling sessionsEliminate stress and poor self image Diet and nutritionMoshe Daniel NDPrognosisVery Good!Most get relief from simple treatmentSome go into remissionOnly 2-3% mortality rateFun FactsRadix family of Chinese herbs can help with

10、symptoms.Gravitax, a combination of iron, aloe vera, and apiaceaeFirst discription of MG in 16721935 Prostigmin Demonstration for MGSourcesDaniel, Moshe. The Treatment and Philosophy of Healing For Myasthenia Gravis . 29 Sep 2007 12 Dec 2021 . Howard, James, F. About Myasthenia Gravis. For Health Care Professionals 30 Sep 2006 12 Dec 2021 . Myasthenia