1. Presented by: Jessica Faye Manansala

2.  Myasthenia gravis, an autoimmune disorder
affecting the myoneural junction, is characterized
by varying degrees of weakness of the voluntary
muscles.
 Women tend to develop the disease at an early age
(20-40 yrs of age)
 In men (60-70 yrs of age)

5.  Ocular muscle – diplopia (double vision)
 Ptosis (drooping of the eyelid)
Major signs and symptoms
 Bulbar symptom- weakness of the muscle of face and throat
 Generalized weakness- resulting decrease vital capacity and
respiratory failure
 Dysphonia (voice impairment)- this may result increase
risk for choking and aspiration
Myasthenia gravis is purely a motor disorder with no
effect on sensation or coordination.

6.  Myasthenic crisis
 Cholinergic crisis

7.  is an exacerbation of the diseaes process.
 Crisis may result from disease exacerbation or a
specific precipitation event.
Most common precipitator is infection; medicattion
change, surgery, pregnancy and high environmental
temp.
Symptoms
 Severe generalized muscle weakness and respiratory
 And bulbar weakness that may result respiratory
failure

8.  Symptoms of anticholinergic overmedication may
mimic the symptoms of exacerbation
 Differentation can be achieved with the edrophonium
chloride (tensilon) test.
Difference between myasthenic & cholinergic
Myasthenic- improves immediately following
adminstration of edrophonium
Cholinergic- crisis may experience no improvement or
deteriorate

9. Myasthenic crisis – neostigmine methylsulfate,
prostigmine is admin IM or IV until the pt. is able to
swallow oral anticholinestrase meds.
-plasma pheresis and IVIG- reduce antibody load
Cholinergic crisis – all anticholinestrase meds should be
stop
- Atrophine sulfate should be given- an antidote for
anticholinestrase medication.

10.  Anti cholinestrase test
 Edrophonium chloride (tensilon) injected through IV
- 2mg at a time to a total of 10mg (30sec after injection,
facial muscle weakness & ptosis should resolve for
about 5min=+). Atrophine (o.4mg)should availabale
for side effects.
 Repetitive nerve stimulation test- it records the
electrical activity in target muscle after nerve
stimulation.
 MRI- for enlarged thymus gland

11. Administration of anticholinestrase agent
 Pyridostigmine bromide (mestinon) & neostigmine
bromide (prostigmine)
Effect: provide symptomatic refief by increasing the relative
concentration of available acetylcholine at the neuro
muscular junction. Improve strength and less fatigue
Immunosuppresive therapy
 Corticosteroids
Effect: to reduce production of the antibody
Prednisone taken on alternate days to lower the incidence of
side effects.

12.  Plasmapheresis- blood cells & antibody containing
plasma are separated, then cells and plasma
substitutes are reinfused.
Effect: plasma exchange used to treat exacerbations. The
improvement may last only a few weeks
IV immune globulin – nearly effective as plasmapheresis
in controlling symptoms exacerbation.
 Thymectomy - it can decrease or eliminate the need for
medication