1、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 FentanylPrecaution for sux,Pathophysiology,Auto Immune Antibodies attack Ach Receptors Decreased cel
2、l excitement Electrical threshold No action potential 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,Classific
3、ation,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
4、 Predominantly limb or axial muscles Predominantly bulbar or respiratory muscles 5: Intubation needed to maintain airway,Whos 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),D
5、iseases Typically Associated With MG,Diabetes Type 1 Rheumatoid Arthritis Lupus Demyelination CNS Disease Other Auto immune diseases,What will we see?,Hallmark S/S Eye lid drooping (ptosis) Impaired speech (dysarthria) Difficulty Swallowing (dysphagia) Double Vision (dipoplia) Easily fatigued, quick
6、 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 Short
7、ness 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, difficu
8、lty 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 acetylcholinester
9、ase 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 treatm
10、ent 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 He
11、aling For Myasthenia Gravis .“ 29 Sep 2007 12 Dec 2008 . Howard, James, F. “About Myasthenia Gravis.“ For Health Care Professionals 30 Sep 2006 12 Dec 2008 . “Myasthenia gravis.“ Wikipedia. 2008. Wikimedia Foundation Inc. 12 Dec 2008 . “What causes Myasthenia Gravis.“ Myasthenia Gravis Fact Sheet 25 Jul 2008 12 Dec 2008 .,Thats All,
