Mysthenia gravis is an autoimmune neuromuscular disease caused by antibodies blocking or reducing acetylcholine receptors at the neuromuscular junction, resulting in fluctuating muscle weakness that worsens with activity and improves with rest. It can affect any muscle and occur at any age or gender. Symptoms may include ptosis, difficulty swallowing or speaking, and weakness of facial or eye muscles. Diagnosis involves testing for acetylcholine receptor antibodies and imaging for potential thymoma. Treatment options include acetylcholinesterase inhibitors to increase acetylcholine levels, immunosuppressants to reduce antibody levels, plasma exchange to remove antibodies, and immunoglobulins for crisis situations.

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