1. Miastenia Gravis actualización Dr. Juan Lozano

2. Thomas Willis (1621-1675), English physician, published a book, De anima brutorum (1) in 1672 in which he wrote about "a woman who temporarily lost her power of speech and became 'mute as a fish. '"(1) This has been interpreted as being the first written description of myasthenia gravis. Thomas Willis was born in Great Bedwin, a Wiltshire village in England. He graduated from Oxford University Legion with a Bachelor of Medicine in 1646. In 1660 he was appointed Sedleian Professor of Natural Philosophy at Oxford and given the M.D.(2)

3. Her first patient, 'Mrs. M.', had had intermittent weakness for 14 years and had been admitted to St. Alfege's Hospital about 2 months prior to the treatment given by Dr. Walker because of an exacerbation. Mrs. M's muscle power was restored about 30 mins after the hypodermic injection of physostigmine sulphate (gr. 1/60) --- the effect lasted up to 4 hours. The case was written up in the Lancet 2nd June 1934, pp. 1200-1 and was also reported in the local newspaper The Kentish Mercury on 15th March 1935. Dra. Mary Walker

4. Paciente de la Dra Walker 'Mrs. M.' before (left image) and after (right image) injection of physostigmine. Before - patient cannot raise left eyelid. After - eye is fully open. These photos were reproduced from a cine film and appeared in reverse (right for left) in The Lancet 1934 (i) 1200-1. They are reproduced here with correct orientation.

7. Julie Long artista Jerry lewis

11. Unión neuromuscular

12. Edad de inicio 2a. y 3a. década en la mujer. 7a. y 8a. década en el hombre Los hombres son mas afectados que las mujeres.

22. DEBILIDAD FATIGABLE

29. Despues de tensilón Prueba de tensilón Antes de tensilón

35. Steinert Kearn-sayre

37. Dosis equivalentes de anticolinesterasicos Dosis (mg) y vía Oral IM IV Jarabe Neostigmina 15 Neostigmina 1.5 0.5 Mestinon 60 2 0.7 60 mg 5 ml Mestinon Timespan 90 - 180 Ambenomio 7.5

39. Glucocorticoides Efectos secundarios a largo plazo Gastrointestinales Nausea,vómitos, Gastritis, ulceras Dermatologicos ac né, hirsutismo Cushing Endocrino s: Hiperglucemia Hipokalemia . Inmunológicos : Inmunodepresión. Hematológicos : petequias Cardiovascular HAS edema Oftalmológicos : Cataratas Glaucoma Psicológicos: Depresión Insomnio. Otros: Aumento de peso

40. Azatioprina Efectos secundarios Gastrointestinales Nausea,vómitos,diarrea Ulceras,malestar Hematológicos Leucopenia, anemia Trombocitopenia. Hepático Enzimas Hepáticas elevadas Inmunológico Mayor susceptibilidad a infecciones Neoplásico Incrementa el riesgo para linfoma

42. TIMOMA

45. El que alguien toque mi vida es un privilegio, Tocar la vida de alguien es un honor, Pero el ayudar a que otros toquen sus propias vidas Es un placer indescriptible! Rubén Darío

53. Mechanism of Action of Nondepolarizing Neuromuscular Blocking Drugs

57. Depolarizing Agents

60. Cholinesterase Inhibitors

62. Myasthenia Gravis

63. Myasthenia Gravis is an autoimmune Disease that is characterized by a decrease in number of AChR Because there are fewer AChR to bind to the end plate potentials (EPPs) are smaller. With smaller EPPs the “ safety factor” is reduced there is less chance that the post-synaptic muscle fibres will be activated

64. Note: The amplitude of the end plate-potential is directly related to the amount of ACh that binds to the post-synaptic AChRs.

65. Myasthenia Gravis

67. Malignant Hyperthermia Dantrolene (interferes with EC coupling by decreasing Ca exflux from the SR

68. Diazepam (A Benzodiazepine that probably f acilitates the actions of GABA A in the CNS) Baclofen (GABA B agonist – note error in your handouts) Primarily used in the treatment of spastiticy associated with spinal cord injury Spasmolytic Drugs