| Disease |
MYASTHENIA GRAVIS |
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| Quotation |
“it is not that the number of nervous diseses that has grown but the number of doctors able to study the diseases.” |
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| Definition |
Commonest of Neuromuscular transmission disorders with fluctuating weaknes of voluntary muscles due to presence of gammaglobulin antibody (Ach R-ab) to receptors at the neuromuscular junction. |
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| Prognosis |
Course highly variable with exacerbations and remissions. Previously poorly controlle cases have done well with combinations of steroid and azathioprine. Acutely ill cases have done well with immunotherapy and intensive care. Therapy with plasma exchange and immunoglobulin has greatly improved the outlook for patients. |
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| General Measures |
Serial monitoring of forced vital capacity for detecting incipient respiratory failure. Crisis (characterized by respiratory failure due to muscle weakness) is managed by endotracheal incubation and positive pressure ventilation, in hospital setting. |
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| Advice to Patient |
Wear a bracelet indicating disease condition. Take the medication exactly as prescribed. The drug may have tobe taken for lifeTake the drug with food or milk to decrease gastric irritation. Several drugs like aminogycosides, tetracyclines, penicillin, chloroquikn, Sulpha, beta-blockers, and phenytoin may aggravate the condition, and should be avoided. Only curariform drugs are absolutely contraindicated. |
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| Follow Up |
At regular intervals when stable, and more frequently when the response is inadequate or cholinergic crisis is suspected. |
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| Inadequate Response |
Patient failure in not taking drugs at intervals specified.More severe form of disease not responding to anti-cholinesterase drugs, and perhaps needing Thymectomy or steroids. |
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| Prevention |
Website: www.macalester.edu/-psych/whathap/UBNRP/Gravis/management-intro.html |
