dr jignesh vora

1. D R . J I G N E S H V O R A
Mysthenia gravis

2. overview
 ch. auto immune disease
 Neuromuscular disease
 Due to defect in transmission of nerve impulses to
muscle / neuromuscular junction is interrupted
 Acetylcholine-ach is neurotransmitor & ach receptor
in muscles . Due to which muscles contract
 > wkness during activity & < wkness by rest
 Can occur in any age & gender
 Thymoma can cause MG

3. Symptoms
sudden onset
Ptosis
Slurred speech – disarthria
Wkness facial muscles
Diffi in swallowing

4. Types
class 1 - an eye muscle wkness - ptosis
class 2 - bulbar & respiratory muscles

5. Dx
RNS
Ach antibody
MUSK- muscle specific kinase antibody
CT / MRI for thymoma

6. Rx
Anti cholinesterase
prevent destruction of ach & > muscle tone
eg. Neostigmin [ i. m.]
pyridostigmin [ oral ]
Immunosuppresive
>muscle strength by < abnormal antibodies
eg. Prednisolone
azathioprine
mycophenolate mofetil- MMF
tracolimus

7. Plasma pheresis
Removing antibody fm plasma like dialysis
In mysthenic crisis
immunoglobulins

8. anticholinergic
Glycopyrrolaate – does nt cross brain barrier
 Used with pyridostigmin & neostigmin to prevent
muscarinic effects of them
actions
 < Silorrhoea - > salivation
 < Tracheobroncheal secretion
 < Sweating- fever- heat stroke
 < urination
 Constipation – h’che
 drowsiness

9. pyridostigmin
Prevents breakdown of ach
> muscle tone
ADRs - > saliva , > urination , > sweating

10. MMF
IMMUNOSUPPRESSANT
ADRs – diarrhoea, NV , fatigue, h’che, cough,
> lymph node, sore throat, leucopenia