Mysathenia Gravis Flashcards
Mys
Muscle
Asthenia
Weakness
Gravis
Serious
What is Mysathenia Gravis?
Autoimmune disease which results from antibodies that block or destroy nicotinic acetylcholine receptors at the junction between the nerve and muscle.
Is MG a Pre-synaptic or Post-synaptic disorder?
Post-synaptic disorder
MG is prevalent in what gender?
Females>Males
Tumor in the thymus
Thymoma
Manifestations for MG
- Weakness and rapid fatigue of any of the muscles under voluntary control.
- Eyes, Face, and Muscles for swallowing
- PTOSIS (CN3) (Ophthalmoplegia)- Drooping of one or both eyelids
- Proximal> Distal Weakness (Mostly affects cervical extensors)
- Decrementing
Response to Exercise - Heat Sensitivity
Drooping of one or both eyelids
PTOSIS- CN3 affectation
Which may be horizontal or vertical, and improves or
resolves when one eye is closed
Diplopia
sustained tight closure of the eyelids can induce fatigue of the orbicularis oculi muscles resulting in the white sclera of the eye slowly becoming apparent under the partially open eye.
Peek Sign
Factors that Can Worsen Myasthenia Gravis
- Fatigue
- Illness
- Stress
- Extreme Heat
- Medications- beta blockers, calcium channel blockers, quinine, and some antibiotics
What do you call about the classification for Myasthenia?
Myasthenia Gravis Foundation of America Clinical Classification Scale
Any ocular weakness
Class 1
Mild Weakness. May also have ocular muscle weakness of any severity.
Class 2
Mild Weakness. Predominantly affecting limb, axial muscles, or both. May also have lesser involvement of oropharyngeal, respiratory muscles or both.
Class 2A
Mild Weakness. Predominantly affecting oropharyngeal, respiratory muscles, or both. May also have lesser of equal involvement of limb, axial muscles or both.
Class 2B
Moderate weakness affecting other than ocular muscles. May also have ocular muscle weakness of any severity.
Class 3
Severe Weakness affecting other than ocular muscles. May also have ocular muscle weakness of any severity.
Class 4
Moderate Weakness. Predominantly affecting limb, axial muscles, or both. May also have lesser involvement of oropharyngeal, respiratory muscles or both.
Class 3A
Moderate Weakness. Predominantly affecting oropharyngeal, respiratory muscles, or both. May also have lesser of equal involvement of limb, axial muscles or both.
Class 3B
Severe Weakness. Predominantly affecting limb, axial muscles, or both. May also have lesser involvement of oropharyngeal, respiratory muscles or both.
Class 4 A
Severe Weakness. Predominantly affecting oropharyngeal, respiratory muscles, or both. May also have lesser of equal involvement of limb, axial muscles or both.
Class 4B
Defined by intubation, with or without mechanical ventilation, except when employed during routine post op management.
Class 5
It is performed by keeping icepacks over eyes for 2-5 minutes & looking at improvement in Ptosis.
Ice Pack Test
Diagnostic Evaluation for MG
- Ice Test or Ice Pack Test
- Single Fiber EMG
- Imaging Scans
- Pulmonary Function Testing
- Edrophonium Test/ Tensilon Test
Medical Management for MG
- Anticholinesterase Medications (mestinon or pyridostigmine)
- Immunosuppressive drugs (prednisone, azathioprine, mycophenolate mofetil, tacrolimus, and rituximab)
Surgical Management for MG
Thymectomy
Assessments
- Ineffective airway clearance
- Impaired verbal communication
- Impaired Physical Mobility
- Activity Intolerance
PT Management for MG
- Aerobic Exercise
- Respiratory Muscle Training
- Strength Training
- Progressive Resistance Exercises
