kh
MYASTHENIA
GRAVIS
SUBMITTED TO: SUBMITTED
kh
MYASTHENIA GRAVIS
INTRODUCTION: Myasthenia Gravis The name myasthenia gravis, which is
Latin and Greek in origin, means "grave, or serious, muscle weakness.“
Autoimmune disease affecting the neuromuscular junction. Not a brain disorder –
brain functions normally Characterized by fluctuating muscle weakness and
fatigability Disease may be generalized or ocular specific
DEFINITION:
Myasthenia gravis is an autoimmune disorder affecting the
myoneural junction, is characterized by varying degrees of weakness
of the voluntary muscles.
CAUSES:
In MG, the receptors at the muscle surface are destroyed or deformed by
antibodies that prevent a normal muscular reaction from occurring.
The causative factor is unknown, but the disorder may have a genetic link.
RISK FACTORS:
Risk factors for myasthenia gravis include:
Female gender and age under 40 years
Male gender and age over 60 years
Other autoimmune disorders
Factors that can worsen myasthenia gravis
Fatigue
Illness
kh
Extreme heat
Some medications - such as beta blockers, calcium channel blockers,
quinine and some antibiotics.
PATHO PHYSIOLOGY:
Due to etiological factors
Lymphocyte produce acetylcholine receptor antibodies
that attack the post synaptic musclmembrane
Depletion of acetylcholine receptor of the
neuromuscular junction
Defect in the transmission of impulse from nerve to
muscle cell
Myasthenia gravis.
SIGN AND SYMPTOMS:
Diplopia and ptosis
Weakness of the muscles of the face and the throat, and generalized
weakness. Weakness of the facial muscles results in bland facial
expression.
kh
Laryngeal irritation causes voice impairment and dysphonia and
increases the patient's risk for choking and aspiration.
Generalized weakness of all the extremities and the intercoastal
muscles resulting in decreased respiratory capacity and vital
capacity.
Myasthenia gravis is purely a motor disorder with no effect on
the sensation and coordination.
DIAGNOSTIC TEST:
Edrophonium test:
Injection of the chemical edrophonium (Tensilon) may result in a
sudden, although temporary, improvement in muscle strength - an
indication that patient may have myasthenia gravis.
Blood analysis
A blood test may reveal the presence of abnormal antibodies that disrupt the
receptor sites where nerve impulses signal muscles to move.
Ice Pack Test
Cooling may improve
neuromuscular transmission. In a patient with myasthenia gravis who has
ptosis, placing ice over an eyelid will lead to cooling of the lid, which leads
to improvement of the ptosis.
Repetitive nerve stimulation
kh
Pulmonary function tests
MEDICAL MANAGEMENT:
Cholinesterase inhibitors. Medications such as pyridostigmine
(Mestinon, Regonal) and neostigmine (Bloxiverz) enhance communication
between nerves and muscles. These medications aren't a cure, but they
can improve muscle contraction and muscle strength in some people.
Possible side effects include gastrointestinal upset, diarrhea, nausea, and
excessive salivation and sweating.
Corticosteroids. Corticosteroids such as prednisone inhibit the immune
system, limiting antibody production. Prolonged use of corticosteroids,
however, can lead to serious side effects, such as bone thinning, weight
gain, diabetes and increased risk of some infections.
Immunosuppressants. medications that alter your immune system, such
as azathioprine (Azasan,, Imuran) mycophenolate mofetil (Cellcept),
cyclosporine (Sandimmune) methotrexate (Trexall) or tacrolimus
(Astrograf XL, Prograf). These drugs, which can take months to work,
might be used with corticosteroids.
Side effects of immunosuppressants, such as increased risk of infection
and liver or kidney damage, can be serious.
Plasma therapy
SURGICAL MANAGEMENT:
Surgery
Thymectomy; surgical removal of the thymus gland
The role of the thymus gland in MG is not fully understood, and the
thymectomy may or may not improve a child's symptoms.
Plasmapheresis: - a procedure that removes abnormal antibodies from the blood
and replaces the child's blood with normal antibodies through donated blood.
Extent of the problems is dependent on the severity of the condition and
kh
the presence of other problems that could affect the child.
In severe cases, a breathing machine may be required to help the child
breathe easier.
The healthcare team educates the family after hospitalization on how to
best care for their child at home and outlines specific clinical problems
that require immediate medical attention by their physician.
A child with MG requires frequent medical evaluations throughout his/her
life.
It is important to allow the child as much independent function and
self-care, especially with juvenile MG, as possible and to promote age
appropriate activities to ensure a sense of normalcy.
About 15 percent of the people who have MG have a tumor in their
thymus, a gland under the breastbone that is involved with the immune
system, thymus will be removed
For people with MG who don't have a tumor in the thymus, it's
unclear whether the potential benefit of removing the thymus
outweighs the risks of surgery.
This is an individualized decision between patient and the doctor, but
most doctors don't recommend surgery if:
Symptoms are mild Symptoms involve only the eyes
Patients over 60 years old.
Myasthenia Gravis through yoga
Yoga Exercises Help to stretch the body which increase the
flexibility as well as strengthen the muscles of the body,
which become weak due to MG.
Improve blood circulation and remove carbon dioxide from
the body & provide oxygenated blood to every part of the
body.
kh
Pranayama - yoga breathing
Helpful because the onset of MG often lead to mild depression but the
practice of breathing exercises like,
Nadi- Shodan,
Anulom-Vilom,
Deep breathing and
Mild Kawabata Helps to remove depression and relax the mind as well as the
body.
Meditation also brings more positive thinking.
Nutrition;
Along with exercises & breathing practices eating habits should also be
altered.
Simple, nourishing, no stimulating foods, including plenty of fresh fruits
& lightly cooked vegetable, particularly greens.
Asparagus is considered excellent since it contains certain natural steroid-
like nutritious elements, which help strengthen the weakened muscles
caused by MG.
Whole meal grains, sprouts & pulses in places eggs and meats.
Food should have a blend of all necessary vitamins.
Reduce protein intake to 10 percent of total calories; replace animal
protein as much as possible with plant protein
Eliminate milk and milk products (substitute other calcium sources).
kh
Eat more fruits and vegetables (make sure that they are organically
grown).
Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening,
all partially hydrogenated oils, and all foods (such as deep-fried foods)
that might contain trans-fatty acids.
Use extra-virgin olive oil as your main fat.
Take ginger.
NURSING MANAGEMENT
Maintain patent airway
Assess swallowing to prevent aspiration
Keep appropriate equipment available at the bedside: Oxygen, suction,
Ambu bag, endotracheal intubation
Promote energy conservation measures
Consult Physical Therapy for medical equipment needs (i.e.walkers,
wheelchairs)
Consult OT for assistive devices to facilitate ADLs
Consult with speech and language therapist if weakening facial muscles
impact communication Monitor I/O,
serum albumin levels, and daily weights
Know the signs and symptoms of both Myasthenic Crisis
Administer Medications as per order.
Conclusions:
Myasthenia Gravis is a very complex disease with many different signs and
symptoms, which may be quite noticeable or vague. The presenting symptoms
of ptosis and/or diplopia should cause the clinician to consider a work-up for
MG
Bibliography:
A text book of medical surgical nursing -LEWIS VOL -1,2nd edition.
A text book of medical surgical nursing ,brunner and suddartha ,13th edition
Vol-2.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516054/.
kh
kh
