Myasthenia gravis is an autoimmune disorder where antibodies attack acetylcholine receptors at the neuromuscular junction, impairing nerve impulse transmission and causing muscle weakness. Symptoms include drooping eyelids, double vision, facial weakness, and difficulty swallowing and speaking. Diagnosis involves tensilone tests, ice pack tests, blood analysis, nerve stimulation tests, pulmonary function tests, and EMG. Treatment options include cholinesterase inhibitors to enhance nerve-muscle communication, corticosteroids to limit antibody production, immunosuppressants, plasmapheresis to remove antibodies, and thymectomy.

2. DEFINITION
 Myasthenia gravis is an auto immune disorder
affecting the myoneural junction, is characterised by
varying degree of weakness of the voluntary muscle.
( Brunner & siddarth)

5. ETIOLOGY/PATHOPHYSIOLOGY:-
 Normal:-
 A chemical impulses precipitate the release of
acetylcholine from vesicles on the nerve terminal at
the myoneural junction.
 Then the acetylcholine attach to the receptor site of
the motor end plate & stimulate the muscle
contraction.

6. In case of Myasthenia gravis:- Antibody attack the acetyle cholin receptor.
 So there is decrease no of Ach receptor site at the
neuromuscular junction.
 It impair the transmission of nerve impulse across the
neuro muscular junction which cause muscle
weakness.
 The abnormal antibody release due to thymic
hyperplasia, thymic tumour because thymus gland is
the site of antibody production.

8. Clinical manifestation:-
 Diplopia & ptosis
 Bland facial expression due to weakness of facial
muscle.
 Dysphonia ( Voice impairement due to laryngeal
involvement)
 Decrease intercostals muscle vital capacity which
causes respiratory failure.
 Difficulty in chewing, swallowing, speaking.

9. DIAGNOSIS:-
 History collection:-
 Physical Examination:- Check neurological health by testing
reflexes, muscle strength, muscle tone, coordination, balance.
 Tensilone test:- Edrophonium chloride is a acetylcholinesterage
inhibitor is administer IV to stop the break down of acetylcholin &
30 second after injection facial muscle weakness & ptosis resolve for
5 min.
 Ice pack test:- A beg full of ice is placed on pt eye after some time
when it removed eye lid open by its own for few min.
 Blood analysis:- To find out abnormal ability
 Receptive nerve stimulation:- Here doctor send small pulses of
electricity through electrode to measure the nerve ability to send
signal to muscle.
 EMG:- It measure electrical activity travelling between brain &
muscle by inserting a fine wire electrode through skin & into a
muscle to test a signal muscle fiber.
 Pulmonary function test:- To evaluate whether the condition affect
the lungs.

10. MEDICAL MANAGEMENT:-
 Cholinesterase inhibitor:- It enhance the communication
between nerve & muscle & improve muscle concentration
& strength. Ex- Pyridostigmine.
 Corticosteroid:- Corticosteroid such as prednisone
inhibit the immune system limiting antibody production.
 Immunosuppressant:- To alter the immune system. Ex-
Cyclosporine, methotraxate.
 Plasmapherasis:- Blood will routed through a machine
that remove the antibodies that block the transmission of
signal.
 Thymectomy:- Removal of thymus gland.