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Myasthenia Gravis - Paper

Myasthenia Gravis


"As a physician, there is nothing as gratifying as administering Tensilon to an undiagnosed myasthenic patient… except maybe giving benadryl to a patient who OD'd on compazine."
-Kenneth R. Einberg MD, 1999
Introduction
(MG) is one of the most common neuromuscular disorders, characterized by skeletal muscle weakness that fatigues. MG is one of the best-described autoimmune diseases, caused by antibodies produced against post-synaptic receptors at the neuromuscular junction (nmj). Treatments are aimed at reducing circulating antibodies, increasing neurotransmitter availability, and immune suppression. No cure is yet available.

Epidemiology

While MG has been classically understood as a ...

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feature of MG is muscle weakness and fatiguability. The muscles most commonly affected are the oculomotors, which cause ptosis or diplopia. MG can also commonly present with oropharyngeal muscle weakness. The patient may regurgitate food through the nose, be unable to chew meat, speak in a markedly ‘nasal’ tone, or have a history of choking on food/secretions. MG can also present with limb weakness and rarely respiratory distress. The weakness typically (but not always) worsens as the day progresses, especially after prolonged use of the affected muscles. The course of the disease is variable but usually progressive, progressing from local to generalized involvement. Spontaneous improvement may occur in up to 1/3 of untreated patients, and occurs early in the disease progression.
On physical exam, strength is assessed repetitively during maximum effort and again after brief periods of rest. Patients may have asymmetrical weakness of oculomotor muscles in both eyes, as well ...

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of voltage-gated sodium channels in the synaptic folds of the endplate, increasing the action potential threshold and reducing the probability of muscle depolarization in response to motoneural stimulation.
The autoantibody sythesis in MG is under the influence of autoreactive T cells in the thymus. About 10% of patients with MG have a thymic tumor, and up to 70% have evidence of thymic hyperplasia. The frequency of thymoma decreases with age. It is not understood if the role of the thymus in MG is primary or secondary. Patients with thymoma usually have more severe disease, higher levels of AchR antibodies, and more sever EMG abnormalities than patiens without thymoma. ...

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PAPER DETAILS
Added: 12/30/2007 01:14:58 PM
Category: Health & Medicine
Type: Premium Paper
Words: 1269
Pages: 5

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