NEUROLOGY

Manohar MD
Neuromuscular Junction
 NEUROMUSCULAR
JUNCTION DISEASES
• Myasthenia gravis
• Eaton Lambert syndrome
• Organoposphorus poisoning
 Myasthenia Gravis
• Progressive Fatigable weakness of
Muscles - Ocular
- Neck
- Facial
- Bulbar
Pathogenesis
 Pathogenesis
• Autoantibodies to Acetyl choline
receptors in post synaptic membrane
 Clinical features
• Age – 15-50yrs
• Gender – Female more common than
male
 c/f
• Fatigable weakness
• Muscles involved – Ocular
- Neck and
Facial
- Bulbar
• Initially fluctuating – then persisting
• Myasthenic crisis
 Investigations
• Tensilon test – Edrophonium
• Antibodies – AChR, Anti MuSK
• Repetitive nerve stimulation test

• CT thorax – to look for Thymoma

 Treatment
• To decrease activity of acetyl
cholinesterase
• To reduce immunological attack
 Immunological treatment
• Plasma exchange
• IV Ig
• Steroids
• Other immunosupressants
• Thymectomy
 Other Myasthenia
syndromes
• Lambert Eaton Myasthenic syndrome
Para Neoplasitc
Due to antibodies to pre synaptic
calcium channels
Weakness , loss of reflexes – which
improve with exercises
Diagnosis – by elctrophysiological study
Thank you …