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MIASTENIA GRAVIS

:
A REVIEW

20 per 100.000 populasi
Amerika Serikat

■ <40 tahun  wanita: pria = 3: 1
■ 40 dan 50 tahun  sama
■ >50 tahun  sering pada laki-laki

50%
ASIA  MG okular

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Aspek Sejarah

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KLASIFIKASI ■ MG onset dini ■ MG onset lambat ■ MG terkait thymoma ■ MG dengan antibodi anti-MUSK ■ MG okular (oMG) ■ MG tanpa terdeteksi ACHR dan otot spesifik tyrosine kinase (MuSK) antibodi 4 .

otot aksial. atau keduanya 5 . pernafasan. atau keduanya ■ semua kekuatan otot lainnya ■ keterlibatan otot orofaring yang lebih normal sedikit MG Kelas II MG Kelas IIb ■ kelemahan ringan yang ■ didominasi kelemahan otot mempengaruhi selain otot okular. atau ■ kelemahan otot okular pada tingkat keduanya keparahan apapun ■ keterlibatan yang lebih sedikit atau sama dari anggota gerak. orofaringeal. KLASIFIKASI KLINIS MG Kelas I MG Kelas IIa ■ kelemahan otot okular ■ didominasi kelemahan otot anggota ■ kelemahan saat menutup mata gerak. otot aksial.

otot aksial. atau keduanya. ■ keterlibatan otot orofaring yang  kelemahan otot okular pada tingkat keparahan apapun. atau keduanya. lebih sedikit. okular. 6 . mempengaruhi otot selain otot okular  keterlibatan yang lebih sedikit atau ■ kelemahan otot okular pada sama dari anggota gerak. atau keduanya tingkat keparahan apapun MG Kelas IIIa MG Kelas IV ■ terutama memengaruhi otot  kelemahan berat yang mempengaruhi otot selain otot ekstremitas. otot aksial. pernafasan. KLASIFIKASI KLINIS MG Kelas III MG Kelas IIIb ■ kelemahan moderat  didominasi otot orofaringeal.

atau keduanya. atau keduanya. ■ keterlibatan otot orofaring yang lebih sedikit. MG Kelas IVb ■ otot-otot pernafasan oropharyngeal yang dominan atau keduanya. kecuali ketika digunakan selama manajemen pasca operasi rutin. otot aksial. MG Kelas V ■ intubasi dengan atau tanpa ventilasi mekanik. KLASIFIKASI KLINIS MG Kelas IVa ■ terutama memengaruhi ekstremitas. 7 . otot aksial. ■ keterlibatan yang lebih sedikit atau sama dari anggota gerak. ■ penggunaan tabung pengisi tanpa intubasi menempatkan pasien di kelas IVb.

KLASIFIKASI ■ MG onset dini ■ MG onset lambat ■ MG terkait thymoma ■ MG dengan antibodi anti-MUSK ■ MG okular (oMG) ■ MG tanpa terdeteksi ACHR dan otot spesifik tyrosine kinase (MuSK) antibodi 8 .

MANIFESTASI KLINIS Kelemahan berfluktuasi ■ Ptosis unilateral atau bilateral ■ Diplopia ■ Gejala bulbar: disfagia dan disartria 9 .

(a) Foto pasien dengan MG menunjukkan ptosis kanan parsial. Tutup kiri menunjukkan retraksi pseudolid kompensasi karena persarafan yang sama dari levator palpabrae superioris (hukum Herring). (b) Pasang tes Tensilon: catat peningkatan ptosis 10 .

DIAGNOSIS ■ Uji Tensilon (Edrophonium Chloride) ■ Tes Ice Pack ■ Tes Elektrofisiologi 11 .

Gambar 2: CT scan dada gambar pada pasien dengan MG menunjukkan massa nekrotik besar di mediastinum anterior kiri (panah putih) dan limfadenopati hilus bilateral 12 .

TERAPI ■ Inhibitor Acetylcholinesterase ■ Plasmaferesis ■ Terapi Imunoglobulin intravena (IVIg) ■ Kortikosteroid ■ Obat imunosupresif nonsteroid ■ Timektomi 13 .

REHABILITAS ■ Terapi fisik ■ Terapi okupasi ■ Konseling 14 .

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and courage. and because lemons. spectrum. danger and orange. In the spectrum of visible the deep sea. butter and ripe Is the colour of the clear sky and Is the color of blood. and courage. yellow is found between green violet and green on the optical associated with sacrifice. yellow is found between green violet and green on the optical associated with sacrifice. and because lemons. spectrum.Let’s review some concepts Yellow Blue Red Is the color of gold. danger and orange. 29 . butter and ripe Is the colour of the clear sky and Is the color of blood. In the spectrum of visible the deep sea. It is located between of this it has historically been light. It is located between of this it has historically been light. Yellow Blue Red Is the color of gold.

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