Myasthenia gravis is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigability, primarily affecting women aged 20-30 and men aged 50-60. Key diagnostic methods include antibody testing, electrodiagnostic tests, and the ice-pack test, while treatment options encompass anticholinesterase medications, thymectomy, immunosuppression, and plasmapheresis. The condition often presents with cycles of exacerbation and remission and may involve ocular and proximal muscle weakness.

1. Myasthenia Gravis
Dr. Bhupendra Shah
Assistant Professor
Department of Internal Medicine

2. Angry Young man of Bollywood

3. Myasthenia Gravis
• Is a neuromuscular disorder
• weakness and fatigability
• skeletal muscle

4. PATHOPHYSIOLOGY
• Autoimmune disease
• Anti-ACHR antibodies
• Destruction of anti-
acetylcholine receptor
• Thymus plays a role in
autoantibody formation

5. Clinical features
• Affect all age groups
• Peak incidence: 20-30(women), 50-60(men)
• Weakness and Fatigability on repetition
• Weakness of ocular muscles, facial muscle and
proximal muscles
• Period of relapses and remission

6. Bedside test for Myasthenia Gravis

7. ICE-PACK TEST
• Cube of ice over the eyelid for about 2
minutes improves the ptosis

8. Forward arm abduction test

9. Upward gaze test

10. DIAGNOSIS AND EVALUATION
• Antibodies testing: Anti-AChR antibodies
• Electrodiagnostic testing: Repeated nerve
stimulation test

11. DIAGNOSIS AND EVALUATION
• Anticholinesterase test:
-Edrophonium test
• 2mg iv stat followed by 8 mg IV if no
improvement
• Look the improvement in muscle strength

12. Differential diagnosis
Lambert-Eaton myasthenic syndrome
• Depressed level of reflex
• Dysautonomia
• Weakness improve with activities

13. Associated condition
• Thymic abnormalities
• Hyperthyroidism
• Rheumatoid arthritis

14. Treatment

15. ANTICHOLINESTERASE MEDICATIONS
• Pyridostigmine
• Dose: 30-60 mg
• Frequency: 3-4 times daily

16. Thymectomy
• Thymoma
• All generalised myasthenia gravis

17. Immunosupression
• Steroid:
-Prednisolone: 10-15 mg/day increase every 2-3
days by 5mg/day till marked improvement
• Mycophenolate mofetil,
azathioprine,cyclosporine, tacrolimus and
rituxumab

18. Plasmapheresis and IV immunoglobin
• To provide rapid improvement

20. Thank You