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Myasthenia Gravis
Neuro 2
27
Biology
Graduate
01/22/2013

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Term
how does myasthenia gravis effect normal motor function?
Definition

There is decrease efficiency of neuromuscular transmission in M.G.

 

Decreased # of Ach receptors on muscle endplate

 

Distortion of post-synaptic membrane

 

Autoimmunie disorder produces anti-ACh receptor antibodies (blocks the binding site, damage to the postsynaptic muscle membrane

Term

Is myasthenia gravis the most common neurmuscular transmission disorder?

 

What type of disease is M.G. and what the the characteristics of it?

Definition

Yes

 

Autoimmune disease characterized by:

Fluctuating muscle weakness

Farigability of skeletal muscles

Term

What is the ratio of w/M that get Myastenia Gravis?

 

What is the typical onset of M.G.?

 

Definition

W/M: 3:2

 

20s and 30s for women

 

After 50 and 60s for men

Term
What immune system organ is effected in Myasthenia Gravis?
Definition
The Thymus has abnomalities in 75% of people with MG
Term
What are some of the clinical manifestations of Myasthenia Gravis?
Definition

Fluctuating skeletal muscle weakness

 

Fatigability:

Repetion cause fatigue

 

Rest restores activity

 

Besides weakness, neurological finding WNL

Term
What are the classifications given for Myasthenia Gravis?
Definition

Ocular

Mild generalized

Acute Fulminating (coming on suddenly with great severty)

Late Severe

Term
What is the distribution of muscle weakness in Myasthinea gravis?
Definition

only ocular muscles

or

Generalized muscle weakness 85% of the time

Term
Fluctuating weakness often more noticeable in what muscles, prox or distal?
Definition
Proximal
Term

OF the cranial muscles what muscles are usually effected first in Myasthine gravis?

 

 

Definition
eyelid and eye movements usually affected first
Term
What is the result  of the eye muscles being effected in M.G.?
Definition

Diplopia (double vision)

 

Ptosis (drooping eyelids)

 

 

Term
In myasthenia gravis are reflexes and sensations normal?
Definition
Yes
Term
when looking down to up in a normal position both eyelids are seen to overshoot in a twitch like fashion then return to the ptosis position, T/F?
Definition
T
Term
If there is superior rectus plasy of the eye a sustained upward gaze of the patient will do what?
Definition
The ptosis of the eye will increase
Term
What are some dx symptoms of Myasthenia Gravis?
Definition

History

 

Clinical observation of weakness with continued use and improvement with rest

 

Term
What differential dx techinques can be used with Myasthenia gravis?
Definition

Drug-induced myastenia

 

Hyperthiroidism

 

otulism

 

Intracranial mass lesion

 

Progressive disorders of the eye

Term
What are some test that can be done in order to help dx Myasthenia Gravis?
Definition

Imunologic Testing- to detect ACh receptor antibodies in blood (spec but not sensitive)

 

Pharmacologic testing with Tensilon: an AChEsterase inhibitor

 

Electrophysiologic testing

Term
What is the purpose of Pharmacologic testing with Tensilon: an AChEsterase inhibitor?
Definition

The the enzyme inhibited that breaks down ACh allows ACh more time to find a working receptor increasing muscle function.

 

THis would lead Dr to believe that the person does have M.G.

Term
Electrophysiologic Testing in Myasthenia gravis does what?
Definition
Normal EMG at rest with a rapid decline in amplitude of AP with repetitive stimulation
Term
How is Myasthenia Gravis Medically managed?
Definition

AChE inhibitors:

Improvement of weakness

Does not tx underlying causes

Side-effects: see slide

Toxicity

 

Immunosuppression:

Corticosteroifs (prednisone/Azathioprine)

side effects- weight gain, hypertension, osteoporosis

 

Plasmaphoresis- short term effects only

 

Term
what is the danger of using AChE inhibitors in Myasthenia Gravis?
Definition
high doses produce CNS stimulation gollowed by CNS depression, in addition to a depolarizing neuromuscular blockage and may result in respiratory depression, paralysis, death
Term
What is the prognosis for Myasthenia Gravis?
Definition

Slowly progressive course

 

course of the disease is variable:

 

can be a long term spontaneous relapse that can last for weeks

 

remission are rarly complete or permanent

Term
Myasthenic Crisis is a what and is characterized by what?
Definition

A medical emergency

 

Increasing muscle weakness

 

Respiratory distress*

 

Difficulty talking, chewing, swallowing

 

Weaking of respriatory muscles requires ventilatory assistance

Term
What is the PT's role when dealing with a patient with Myasthenia Gravis?
Definition

Suportive care to assist patient with myasthenia gravis

 

Prefeered practice pattern 4E- impaired muscle performance

 

Deep breathing and coughing exercises

 

Positioning during meals- dysphagia

 

 

Term

When can strength training be done with patients with Myasthenia Gravis?

 

What type of exercise can be done?

Definition

Patients with mild to moderate myasthenia gravis

 

maximal isometric contractions

 

Below fatigue level

 

Improvent in all muscles shown

Term
What are important points of paitent education for those w/ myasthenia gravis?
Definition

Side effects and signs of toxicityof AChe inhibitor meds

 

Teach to plan activities during periods of max energy

 

Enegy conservation tips:

arrange home to prevent unnecessary energy expenditure

Frequent rest periods

 

Avoid:

strenuous exercise

stress

excessive exposure to sun or cold weather

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