i want to know more about myasthenia gravis?

Answer 1

Myasthenia gravis (sometimes abbreviated MG; from the Greek myastheneia, lit. 'muscle disease', and Latin gravis, 'serious') is a neuromuscular disease leading to fluctuating muscle weakness and fatiguability. At about 14 cases per 100,000 (in the U.S.), it is one of the lesser known autoimmune disorders. Weakness is typically caused by circulating antibodies that block acetylcholine receptors at the post-synaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine. Myasthenia is treated with immunosuppressants, cholinesterase inhibitors and, in selected cases, thymectomy.

Signs and symptoms
The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Muscles that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are especially susceptible. The muscles that control breathing and neck and limb movements can also be affected. Often the physical examination is within normal limits.

The onset of the disorder can be sudden or rapid . Often symptoms come and go. The diagnosis of myasthenia gravis is often initially missed.

In most cases, the first noticeable symptom is weakness of the eye muscles. In others, difficulty in swallowing and slurred speech may be the first signs. The degree of muscle weakness involved in MG varies greatly among patients, ranging from a localized form, limited to eye muscles (ocular myasthenia), to a severe or generalized form in which many muscles - sometimes including those that control breathing - are affected. Symptoms, which vary in type and severity, may include asymmetrical ptosis (a drooping of one or both eyelids), diplopia (double vision) due to weakness of the muscles that control eye movements, unstable or waddling gait, weakness in arms, hands, fingers, legs, and neck, a change in facial expression, dysphagia (difficulty in swallowing), shortness of breath and dysarthria (impaired speech, often nasal due to weakness of the pharyngeal muscles).

In myasthenic crisis a paralysis of the respiratory muscles occurs, necessitating assisted ventilation to sustain life. In patients whose respiratory muscles are already weak, crises may be triggered by infection, fever, an adverse reaction to medication, or emotional stress (Bedlack & Sanders 2000). Since the heart muscle is stimulated differently, it is never affected by MG.

Diagnosis
Myasthenia can be a difficult diagnosis, as the symptoms can be subtle and hard to distinguish from both normal variants and other neurological disorders (Scherer et al 2005). A patient may have visited the ENT doctor, the ophthalmologist and even the psychiatrist and waited for years for the right diagnosis.

A thorough physical examination can reveal easy fatiguability, with the weakness improving after rest and worsening again on repeat of the exertion testing. Though this is not often performed, applying ice to the weak muscle groups characteristically improves the weakness. Additional tests are often performed, as mentioned below. Furthermore, a good response to medication can also be considered a sign of autoimmune pathology.

Physical examination
Muscle fatigability can be tested for many muscles. A thorough investigation includes

looking upward and sidewards for 30 seconds: ptosis and diplopia.
looking at the feet while lying on the back for 60 seconds
keeping the arms stretched forward for 60 seconds
10 deep knee bends
walking 30 steps on both the toes and the heels
5 situps, lying down and sitting up completely

Treatment
Myasthenia gravis can usually be controlled with medication. Medication is used for two different endpoints:

Direct improvement of the weakness
Reduction of the autoimmune process
Muscle function is improved by cholinesterase inhibitors, such as neostigmine and pyridostigmine. These slow the natural enzyme cholinesterase that degrades acetylcholine in the motor end plate; the neurotransmitter is therefore around longer to stimulate its receptor. Usually doctors will start with a low dose, eg 3x20mg pyridostigmine, and increase until the desired result is achieved. If taken 30 minutes before a meal, symptoms will be mild during eating. Side effects, like perspiration and diarrhea can be countered by adding atropine. Pyridostigmine is a short-lived drug with a half-life of about 4 hours.

Immunosuppressive drugs such as prednisone, ciclosporin, mycophenolate mofetil and azathioprine may be used. It is common for patients to be treated with a combination of these drugs with a cholinesterase inhibitor. Treatments with some immunosuppressives take weeks to months before effects are noticed.

If the myasthenia is serious (myasthenic crisis), plasmapheresis is used to remove the putative antibody from the circulation. Similarly, intravenous immunoglobulins (IVIg) is used to bind the circulating antibodies. Both of these treatments have relatively short-lived benefits, typically measured in weeks.

Thymectomy, the surgical removal of the thymus gland (which is abnormal in myasthenia gravis patients), improves symptoms in more than 50 percent of patients. Some patients are cured by thymectomy, suggesting that the thymus plays a significant role in the pathogenesis of myasthenia, but it is not considered a definitive cure for the disease. The positive effects from a thymectomy may be seen within weeks to as much as 3-5 years after surgery. Thymoma is relatively rare in younger (<40) patients, but paradoxically especially younger patients with generalized MG without thymoma benefit from thymectomy. Of course resection is also indicated for those with a thymoma, but it is less likely to improve the MG symptoms.

Answer 2

Yeah, what they said. Myasthenia gravis is a Neuro-muscular disease that is decending in nature. This means that is starts at your head and eventually travels toward your feet. It starts by making it difficult for you to speak, eat and swallow. Then your arms and hands are difficult to move. Next you have trouble breathing and end up perhaps on a respirator. Then you have trouble controlling bowel and bladder functions, finally your legs give out and you are bed bound, unable to move, an active mind totally trapped in a dysfuctional body. Plasmaphoresis, is one of the more recent methods that are being used to filter out the antibodies that are attacking the host body and purifies the blood, thereby cleaning it and allowing a person to reverse (or be in remission from) the disease. Dr. Buphendra Khatri is a world re-known specialist in the Milwaukee area. He works out of St. Luke's Aurora. You may wish to look up some of his work.

Answer 3

Information and Resources
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Myasthenia Gravis
Myasthenia Gravis Foundation of America, Inc.

National. 33 chapters. Founded 1952.
Promotes research and education into myasthenia gravis, a chronic neuromuscular disease. Provides supportive services for patients and families. Information and referral. Newsletter, support groups, various web-based services, annual and scientific meetings.
WRITE:
Myasthenia Gravis Fdn.
1821 University Ave. W., Suite S256
Minneapolis, MN 55104
CALL: 1-800-541-5454
651-917-6256
FAX: [phone]
E-MAIL: [e-mail]
WEBSITE: http://www.myasthenia.org
VERIFIED: 4/6/2006
Myasthenia Gravis Patient To Patient

Online.
Offers e-mail support and chat rooms where members can share problems, solutions and support.
E-MAIL: [e-mail]
WEBSITE: http://pages.prodigy.net/stanley.way/myasthenia/patient.htm



Brain & Nervous System Health Center
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Understanding Myasthenia Gravis -- the Basics
What Is Myasthenia Gravis?

Myasthenia gravis is a chronic condition that causes muscles to tire and weaken easily. For example, if you have myasthenia gravis, you may notice that during a meal, your jaw muscles become tired and weak, interfering with your ability to chew food. After you have rested for a little while, the muscles may become strong again, allowing you to resume eating.

This waxing-and-waning weakness of muscles, worsening with use and improving with rest, is a hallmark of this particular disease. There typically are periods when you notice more symptoms (called an exacerbation), interspersed with periods when your symptoms decrease or disappear (called remission).

The disease most commonly affects muscles that control eye and eyelid movement, so the first symptoms you notice may be eyelid drooping and/or blurred or doubled vision. Many myasthenia gravis patients start out with this "ocular myasthenia." The majority will go on to develop weakness in other muscle groups within one or two years.

Myasthenia gravis affecting multiple muscle groups throughout the body is called generalized myasthenia gravis. Other common muscle groups to be affected may make it difficult for you to chew, swallow, smile, shrug, lift your arm up, grip, rise to a stand, or walk up stairs. When the muscles necessary for breathing are affected, a patient is said to be in myasthenic crisis. This is a life-threatening situation.

Though anyone can develop myasthenia gravis, those most likely to do so are women between age 20 and 40 or men between 50 and 70. If a woman with myasthenia gravis gives birth, the baby may have some temporary, but potentially life-threatening, muscle weakness (neonatal myasthenia) because of antibodies that have transferred from the mother's bloodstream. Typically, during the baby's first weeks of life, the antibodies are cleared from the baby's circulation and the baby develops normal muscle tone and strength.
What Causes Myasthenia Gravis?

Under normal conditions, your nerves direct your muscles to work by sending a message through an area called a receptor. The chemical that delivers the message is called acetylcholine. When acetylcholine lodges in a nerve receptor, your muscle knows to contract. In myasthenia gravis, you have fewer acetylcholine receptors than you need.

Myasthenia gravis is considered to be an autoimmune disorder. In an autoimmune disease, your body's antibodies (cells in your body that are supposed to be programmed to fight foreign invaders such as bacteria, viruses, or fungi) mistake a part of your own body as foreign, resulting in its destruction. In the case of myasthenia gravis, your antibodies attack and destroy the acetylcholine receptors needed for muscle contraction.

No one knows exactly what causes your body to begin producing the antibodies that destroy acetylcholine receptors. In some cases, the process seems to be related to the thymus gland, which helps produce antibodies. About 15% of all myasthenia gravis patients are found to have a thymoma, a tumor of the thymus. Although most thymomas are benign, the thymus is usually removed (thymectomy) to prevent the potential spread of cancer. In fact, thymectomy seems to improve symptoms of myasthenia gravis in some patients, even if no tumor is present.

WebMD Medical Reference

SOURCES: The Mayor Clinic. National Institute of Neurological Disorders and Stroke. Myasthenia Gravis Foundation of America

Answer 4

Mya Gravis Disease

Answer 5

you're in all probability refering to the drug neostigmine (Tensilon). Acetylcholinesterase commonly breaks down the nuerotrasmitter acetylcholine. Acetylcholine is the neurotransmitter in charge for muscle contraction. A definiciency in acetylcholine reasons muscle weak spot or, in severe circumstances, paralysis (in spite of the actuality that usuall non everlasting). Neostigmine (Tensilon) stops acethylcholinesterase from breaking down acetylcholine thereby no longer without delay allowing a extra physically powerful quantity of acetylcholine to get carry of. Acetylcholinesterase------------->Brea... down acetylcholine Acetylcholinesterase------/TENSILON/--... Breaks down acetylcholine