Myasthenia Gravis - Summary
 • an autoimmune disease ...
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Description

Myasthenia Gravis - Summary
 • an autoimmune disease of the postsynaptic neuromuscular junction associated with antibodies to the postsynaptic acetylcholine receptors
 • Onset: third decade of life in women and after age 50 years in men
Diagnosis:
 • Based on clinical, serologic, and EMG findings
 • Disease-specific antibodies are found in 90% of patients;
    - 85% have typical MG with acetylcholine receptor antibodies,
    - but 5% have anti—muscle-specific kinase (MuSK) antibodies
    - MuSK-positive myasthenia: More likely to cause focal or severe bulbar, cervical, or respiratory weakness.
 • The characteristic EMG finding of MG is a decremental response to repetitive stimulation.
 • All patients with MG should undergo chest CT to screen for thymoma, a tumor associated with the disease.).
Treatment:
 • Symptomatic treatment Of ocular and mild generalized myasthenia usually
 • Starts with the cholinesterase inhibitor pyridostigmine.
 • In those with more advanced disease, immunosuppressive therapy is required.
    - 1st line: Oral glucocorticoids - can cause transient exacerbation at high doses and should be titrated upward slowly in patients with mild to moderate weakness.
    - In the presence of prominent bulbar or generalized weakness and in myasthenic crisis, treatment with IVIG or plasmapheresis should precede initiation of glucocorticoids.
 • The immunosuppressant agents azathioprine, mycophenolate mofetil, and cyclosporine
 • Thymectomv should be performed in all patients with thymoma.
    - Improves clinical outcome and reduces immunosuppression requirements in patients with generalized MG who are younger than 65 years and within 3 years of diagnosis.

Sinai Hospital of Baltimore IM Residency @SinaiBmoreIMRes

#Myasthenia #Gravis #diagnosis #management #neurology #treatment
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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