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Myastheniagravis 230420035533 4ffc802f
Myastheniagravis 230420035533 4ffc802f
MYASTHENIA GRAVIS
PRESENTED BY-
DIVYA PAL
M.Sc. NURSING I YEAR
OBJECTIVES
2. Class II: Mild weakness affecting other than ocular muscles; may also have
ocular muscle weakness of any severity.
3. Class Ila: Predominantly affecting limb, axial muscles, or both; may also have
lesser involvement of oropharyngeal muscles
CLASSIFICATION
7. Class Ilb: Predominantly bulbar and/or respiratory mack to to top also have lesser
or equal involvement of limb, axial muscle or both.
8. Class IV: Severe weakness affecting other than ocular muscles; may also have
ocular muscle weakness of any severity.
9. Class IVa: Predominantly affecting limb, axial muscles, or both; may also have
lesser involvement of oropharyngeal muscles.
CLASSIFICATION
10. Class IVb: Predominantly bulbar and/or respiratory muscles; may also have
lesser or equal involvement of limb, axial muscles, or both (Can also include
feeding tube without intubation).
• Fatigue
• Stress
• Surgery
• Illness or infection
RISK FACTORS
• Pregnancy
• Menstrual periods
CAUSES
Genetic
• Unknown
TYPES
Respiratory weakness
Ptosis is present initially in 50% of the patients and during course of disease in 90%
of patients.
BULBAR MUSCLE WEAKNESS
• Palatal muscles
• Weakness of the intercostal space muscles and the diaphragm may result in Co2
retention due to hypoventilation.
Assymetric:-
• Usually affects more than one extraoccular muscles and is not limited to muscles
innervated by one cranial nerve. Weakness of lateral and medied recti may
produce & a pseudo internuclear opthalmoplegia.
Lymphocyte produce Ach Receptor antibodies that attack the postsynaptic muscle
membrane.
Myasthenia Gravis
CLINICAL MANIFESTATION
• Diplopia
CLINICAL MANIFESTATION
• Shortness of breath
• Impaired speech
History collection –
The early type (before age of 50) is female predominant and the late type (after age
of 60) is male dominant.
• Race- Some studies demonstrated that the incidence, prevalence and the severity
of this disease is higher inAfrican/Americans.
Photophobia
Facial weakness
DIAGNOSTIC EVALUATION
• Respiratory problems
• Fatigue
• Urinary incontinency
DIAGNOSTIC EVALUATION
Physical examination-
• Co-ordination
• Sense of touch
Edrophonium Tensilon test-This test is used to test eye muscle weakness and uses
injections of edrophonium chloride to briefly relieve weakness. The drug blocks the
breakdown of acetylcholine and temporarily increases the levels of acetylcholine at
the neuromuscular junction.
DIAGNOSTIC EVALUATION
Blood test-People living with myasthenia gravis may have abnormally elevated
levels of acetylcholine receptor antibodies.
A second antibody called the anti- MUSK antibody has been found in about half of
individuals with myasthenia gravis who do not have acetylcholine receptor
antibodies. A blood test can also detect this antibody.
DIAGNOSTIC EVALUATION
Electrodiagnostics-
It is most sensitive test for Myasthenia Gravis. It detects impaired nerve- to-
muscle transmission.
DIAGNOSTIC EVALUATION
Diagnostic imaging-
• CT Scan
DIAGNOSTIC EVALUATION
M.R.I
DIAGNOSTIC EVALUATION
Ice pack test-When edrophonium test is contraindicated , used for patients with
ptosis.
MEDICAL MANAGEMENT
• Cholinesterase inhibitor
• Corticosteroid
• Immunosuppresants
• Plasmapheresis
• IVIg
• Monoclonal Antibodies
MEDICAL MANAGEMENT
Cholinesterase Inhibitor-
https://youtu.be/oTKOxfhJ6AQ
MEDICAL MANAGEMENT
Strength
Flexibility
Mobility
Balance
Gait
Benefits of Exercise in Myasthenia Gravis
Weight reduction.
Mood elevation
• Exercise large, proximal muscle groups for short periods of time building up
only to moderate intensity
A-Adapting the home ,adequate rest ,assistive equipment, asking for help.
Breathing Exercises
Postural Exercises
Aerobic Excercises
Strength Excercises
Swimming
TYPES OF EXCERCISE
Diaphragmatic breathing
TYPES OF EXCERCISE
Postural Exercises-
Keeps bones and joints in the correct alignment so that muscles are being used
properly
Prevents fatigue because muscles are being used more efficiently, allowing the
body to use less energy
TYPES OF EXCERCISE
Strengthen Exercise -
Swimming-
Patients should swim in water where they can touch the bottom.
Monitor respiratory status and ability to cough and deep breathe adequately.
Monitor for respiratory failure.
• Plan short activities that coincide with times of maximal muscle strength.
Instruct the client to avoid stress, infection, fatigue, and over-the counter
medications.
Inform the client about services from the Myasthenia Gravis Foundation.
COMPLICATIONS
• Myasthenic Crisis
PMID:34930325
RESEARCH ARTICLE
Methods- Research studies were extracted from IranDoc, MagIran, Iran Medex,
SID, ScienceDirect, Web of Sciences (WoS), ProQuest, Medline (PubMed), Scopus
and Google Scholar based on Cochran's seven- step guidelines using existing
keywords extracted in MeSH browser. The 12 test was used to calculate the
heterogeneity of studies, and Begg and Mazumdar rank correlation tests were used
to assess publication bias. Data were analyzed using Comprehensive Meta-Analysis
software (Version 2).
RESEARCH ARTICLE
Results- In the search for descriptive studies based on the research question, 7374
articles were found. After deleting articles unrelated to the research question,
finally, 63 articles with a sample size of 1,206,961,907 people were included in the
meta-analysis. The prevalence of MG worldwide was estimated to be 12.4 people
(95% CI 10.6-14.5) per 100,000 population.
RESEARCH ARTICLE
What are the causes and sign and symptoms of Myasthenia Gravis?