Myasthenia Gravis
amount of patients with bulbar involvement
15%
amount of patients with ocular symptoms
50%
tensilon/edrophonium test
AChE inhibitor injected and should see increase in muscle strength
drug treatment for MG
ChE inhibitors immunosuppressive agents
organophosphate poisoning leads to
SLUDGEM from overstimulation of nicotinic cholinergic neurons
pralidoxime
antimuscarinic and antinicotinic with poor BBB penetration
atropine
antimuscuarinic with good BBB penetration
contraindications of tensilon test
asthma allergies elderly pregnant/breast feeding cardiac disease
early MG patients have transient symptoms that last
asymptomatic periods that last few days - weeks
antidote for organophosphate poisoning
atropine pralidoxime
myasthenia gravis characteristics
autoimmune disease where auto-Ab attach ACh receptors at NMJ characterized by weakness and fagitability of skeletal muscles
4 common causes of ptosis
congenital causes age related muscle deterioration in elderly nerve damage muscle weakness
ptosis
drooping of upper eyelids
muscles affected by MG (4)
extraocular pharyngeal facial respiratory
ocular MG
eyelids and extraocular muscles affected
as disease progresses, symptom free periods are lost but
fluctation in symptoms remains
adverse effects of edrophonium test
hypotension bronchoconstriction bradycardia SLUDGEM PNS effects
icepack test
ice pack over eyes with ptosis and neuromuscular transmission should improve with the lower temps
bedside tests for MG (2)
icepack test tensilon/edrophonium test
prednisone
immunosuppressive agent used for autoimmune disorders
first line treatment for MG
manage symptoms like ptosis and diplopia without drugs
prdnisone problems
many side effects especially with long term use
forms of MG
ocular generalized
generalized MG
ocular MG spreads to bulbar, limb, and respiratory musculature
electrophysiologic studies for MG are
repetitive nerve stimulatioin
SLUDGEM stands for
salivation lacrimation urination defecation GI upset emesis miosis and muscle stimulation
diagnosis of MG (3)
serologic tests for autoantibodies electrophysiologic studies bedside tests
serologic test for MG problem
test negative in 6-12% of patients
bulbar musculature
throat muscles
less common causes of ptosis
toxins tumors infections
