Myasthenia gravis is an autoimmune disease affecting the neuromuscular junction, leading to fluctuating muscle weakness, particularly in women during childbearing years and men aged 50-70. Symptoms include ptosis, diplopia, impaired speech, and generalized weakness, with muscle fatigue worsening throughout the day, often triggered by stress or illness. Management involves anticholinesterase drugs, corticosteroids, immunosuppressants, and possibly thymectomy, along with supportive nursing care.

1. MYASTHENIA GRAVIS
BY;
ANUSHRI SRIVASTAVA

2. INTRODUCTION
Myasthenia Gravis is a rare autoimmune disease of the
neuromuscular junction characterized by the fluctuating
weakness of certain skeletal muscles groups.
The peak age at onset in women is during childbearing years; in
men the peak onset of myasthenia gravis is between the ages of
50 and 70 years.
June month is celebrated as myasthenia awareness month.

3. history
Myasthenia Gravis was first recognized as a
distinct clinical entity by THOMAS WILL , a
Oxford Physician.
The first modern description was made in
1877 by Samuel wilk , a London Physician

4. definition
• Myasthenia Gravis is an autoimmune disorder
characterized by weakness and rapid fatigue of
any of the muscles under your voluntary control.
According to WORLD HEALTH ORGANIZATION,
• Myasthenia Gravis is an acquired disease of the
neuromuscular junction characterized by
muscular weakness and fatigability.

5. etiology
Myasthenia Gravis can be caused due to:
• Idiopathic
• Autoimmune attack
Autoantibodies to Acetylcholine receptors
Autoantibodies to Tyrosine kinase receptors
• Thymic tumor
• Congenital

6. RISK FACTORS
• Family History
• Young Women(Age 20 and 30 )
• Men aged 50 and older
• People with vitamin deficiency especially
Vitamin D

7. pathophysiology

8. classification
• Ocular Muscle weakness
• Mild weakness of muscles other than ocular
muscles
• Moderate weakness of muscles other than
ocular muscles
• Severe weakness of muscles other than
ocular muscles
• Intubation

9. CLINICAL MANIFESTATIONS
• Fluctuating weakness of skeletal muscles involves
ocular muscles and muscles that are used to chew,
swallow, speak and breathe.
• Muscles are generally strongest in the morning and
become exhausted with continued activity, but a
period of rest usually stores strength.
• By the end of day , muscles weakness is prominent.
• No sensory loss , reflexes are normal and muscle
atrophy is rare.

10. Clinical manifestation
• Ptosis
• Diplopia

11. • Impaired speech
• Dysphagia
• Difficulty in chewing
• Change facial expression

12. Generalized Weakness
Bulbar Symptoms i.e. weakness of muscles of face
and throat
 Bland facial expression
Dysphonia
It is a term for voice impairment
Impaired Facial motility and expression
Voice often fades after a long conversation
Muscles of the shoulder and hip are more often
affected than the distal muscles

13. Myasthenia crisis
Myasthenia crisis is an acute exacerbation
of muscle weakness resulting in respiratory
failure.

14. triggers
• Emotional Stress
• Pregnancy
• Menstruation
• Another illness
• Trauma
• Temperature Extremes
• Hypokalemia
• Ingestion of drugs like Aminoglycosides, Anticonvulsants,
etc
• Psychotropic drugs like Benzodiazepines, Lithium,
Antidepressants

15. complications
• Aspiration
• Respiratory Insufficiency
• Respiratory Tract Infection
• Cardiomyopathies
• Any other autoimmune diseases

16. Diagnostic evaluation
• History Collection
• Physical Examination
• Electromyography and Single fiber EMG
• Tensilon test
IV injection of Anticholinesterase agent edrophonium
chloride
• Chest CT scan
• Acetylcholine receptors antibodies
• Magnetic Resonance Imaging

17. Medical management
Anticholinesterase drugs like
Physostigmine and neostigmine
Corticosteroids like Prednisone
(alternate day)
Immunosuppressants like Azathioprine,
Mycophenolate Mofetil ,etc.
Plasmapheresis
IV Immunoglobulin G

18. Surgical management
Thymectomy
Removal of thymus gland if there is a
tumor exist.

19. Nursing management
• Assess the patient condition
• Provide comfortable position
• Monitor Vitals
• Assess for dyspnea, dysphagia, dysphonia ,etc
• Administer medication as prescribed by Physician
• IV fluid administration
• Nasogastric feeding if the patient is unable to chew and
swallow the food.

20. Nursing diagnosis
 Ineffective airway clearance related to intercoastal
muscle weakness as evidence by patient
decreased breathing pattern
 Impaired verbal communication related to
weakness of larynx, lips ,moth and jaw as evidence
by patient verbal response
 Activity intolerance related to muscle weakness and
fatigability as evidence by physical examination

21. .
thank you!