7 hours ago · Abstract. Myasthenia gravis (MG) belongs to a spectrum of autoimmune diseases in which anti-acetylcholine receptor antibodies damage neuromuscular junctions. It is a relatively rare disease with a higher incidence among the female population. The classical presentation is fatigable fluctuating diplopia or ptosis and, uncommonly, dysphagia or ... >> Go To The Portal
Tran C, Bril V, Katzberg HD, Barnett C. Fatigue is a relevant outcome in patients with myasthenia gravis. Muscle Nerve. 2018;58:197–203. doi: 10.1002/mus.26069. [PubMed] [CrossRef] [Google Scholar] 37.
Background and objectives: Myasthenia gravis (MG) is an autoimmune neurologic disease that affects the postsynaptic portion of the neuromuscular junction. It represents a challenge for anesthesiologists due to the diversity of disease manifestations and possibility of postoperative respiratory complications.
Myasthenia gravis (MG) is a rare autoimmune disease characterised by antibody-mediated interference with neuromuscular transmission at the neuromuscular junction [1]. MG is classed as a rare disease, and its prevalence is estimated to be about 1–2 per 10,000 people [2].
Myasthenia gravis is an autoimmune disease of the neuromuscular junction for which many therapies were developed before the era of evidence based medicine.
After her blood test results and a physical exam, he diagnosed her with Myasthenia Gravis (MG), class IIa. She was prescribed a cholinesterase inhibitor medication and took time off work to help with her symptoms. Over the summer break, the patient continued to take her medication and took time to rest and relax.
MG is caused when there is an interruption in the communication between the nerve impulse and the muscle at the neuromuscular junction. Antibodies can be formed by a dysregulated immune system and they block or destroy the acetylcholine receptors that would normally be responsible for muscle activation .
Myasthenia Gravis (MG) is a neurological condition involving dysfunction at the neuromuscular junction . It is a rare, but chronic, auto-immune disease that is said to affect approximately 1 in 5000 Americans of varying races, ages and genders .
It is important to address this through various treatment approaches including education, aerobic exercise, and resistance exercise.
The purpose of this fictional case study is to explore the physiotherapy assessment and treatment progression of a 35 year old woman diagnosed with myasthenia gravis (MG), class IIa. The patient discussed in this case study presents with fatigable weakness affecting mainly her upper limbs as well as diplopia. Due to an increased workload, the patient developed right shoulder pain, leading her to seek physiotherapy care. The physiotherapist developed an individualized treatment plan based on the patient’s short and long term goals which involved education, self management strategies, resistance and aerobic exercises, and manual therapy. Outcome measures (QuickDASH and MG QoL 15) were completed upon initial assessment and discharge to assess her progression throughout the 6 week treatment period. By the end of the treatment period, the patient had met all her treatment goals and continued to work on self-management of her MG.
Myasthenia gravis is an autoimmune disease targeting the postsynaptic acetylcholine receptors , which typically presents with fatigue symptoms relieved by rest [1], [2]. It has a bimodal age distribution, with peak onset in the 20–30s with female prevalence, and male prevalence in the 60–80s age range [2]. Majority of patients present with symptoms of fatigue relieved by rest and intact reflexes that may become progressively weaker on repeated use. More than half of patients present with ocular symptoms of ptosis and/or diplopia, which develop into generalized disease within two years. About 15% of patients present with bulbar symptoms, including dysarthria, dysphagia, and fatigable chewing, which requires increased attention due to risk of crisis [2].
Finally, antistriated muscle antibodies target heterogeneous striated muscle proteins and are present in 80% of patients with a thymoma, but only 36% of those with generalized disease. Thus, the presence of different antibodies can sway the treatment regimen, although some 6–12% of myasthenic patients are seronegative.
In a majority of patients with thymus hyperplasia along with positive AChR antibodies, thymectomy may improve the myasthenia condition significantly. Usually, this is about one-third of the affected. Others may enter remission or show no improvement at all.
So, in summary, when a patient presents with generalized muscle weakness with fatiguability, ptosis and double vision or sometimes even with just the eye symptoms alone, there’s a high chance of the condition being Myasthenia Gravis. It is important to carry out timely investigations and interventions for the patients to recover successfully and let them return to their normal or near-normal day to day activities without any long-term complications.
Generalized myasthenia gravis is a rare case of autoimmune wherein the antibodies destroy the post-sinaptic acetylcholine receptors at skeletal muscle’s neuromuscular junctions. The clinical presentation is specific distributin of motoric deficit without sensoric deficit which diminished with rest and worsens with excessive use.
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