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MYSTHENIA GRAVIS

 MYSTHENIA GRAVIS:- 


DEFINITION:- 

• Mysthenia gravis is an autoimmune disorder affecting the myoneural junction ,is characterized by varying degrees of weakness of the voluntary muscles. 

•  antibodies to cholinergic receptors 

Its characterized by grave weakness of the muscle due to the inability of neuromuscular junctions to transmit impulses from nerve to the muscle 

• It is a serious and sometimes a fatal disease. 

• Myasthenia gravis is caused by the body’s immune system attacking the nerves supplying the muscles.

• Women are affected more frequently than men .

•  Myasthenia gravis usually affects younger women, and men over the age of 60.


CAUSES:- 

• Mysthenia gravis is caused due to the development of autoantibodies against the receptors of acetylcholine. 

• That is, the body develops antibodies against its own acetylcholine receptors. 

• These antibodies prevent binging of acetylcholine with its receptors or destroy the receptors.

• So , though the acetylcholine release is normal,  it cannot execute its action.


RISK FACTORS :-

• Risk factors for mysthenia gravis include:-

• Female gender and age under 40 years .

• Male gender and age over 60 years 

• Other autoimmune disorders.


FACTORS THAT CAN WORSEN MYSTHENIA GRAVIS:- 

• Fatigue 

• Illness 

• Stress 

• Extreme heat 

• Some medications ;- such as beta blockers, calcium channel blockers, quinine and some antibiotics.


 SYMPTOMS:-

• Muscles which are more susceptible for mysthenia gravis  are muscle of neck, limbs,  eyeballs , and the muscle responsible for eyelid movements,  chewing,  swallowing  ,speech  and respiration. 


• Common symptoms are :- 

1. Slow and weak muscular contraction because of the defective neuromuscular activity 

2. Inability to maintain the prolonged contraction of skeletal muscle 

3. Quick fatigability when the patient attempts repeated muscular contractions. 

4. Weakness and fatigability of arm and legs. 

5. Double vision and droopy eyelids due to the weakness of ocular muscles.

6. Difficulty in swallowing due to weakness of throat muscles.

7. Difficulty in speech due to weakness of muscles of speech.


NOTES :-• In severe conditions, there is paralysis of muscles, patient dies mostly due to the paralysis of respiratory muscles.


COMPLICATIONS:- 

• Complications of myasthenia gravis are treatable, but some can be life-threatening. 


Myasthenic crisis 

• Myasthenic crisis is a life-threatening condition that occurs when the muscles that control breathing become too weak to do their jobs. 

• Emergency treatment is needed to provide mechanical assistance with breathing. 

• Medications and blood-filtering therapies help people to again breathe on their own. 


Thymus gland tumors 

• Some people with myasthenia gravis have a tumor in their thymus gland, a gland under the breastbone that is involved with the immune system. Most of these tumors, called thymomas, aren't cancerous (malignant). 


Other disorders 


• People with myasthenia gravis are more likely to have the following conditions: 

• Underactive or overactive thyroid. 

• The thyroid gland, which is in the neck, secretes hormones that regulate your metabolism.

•  If your thyroid is underactive, you might have difficulties dealing with cold, weight gain and other issues.

•  An overactive thyroid can cause difficulties dealing with heat, weight loss and other issues. 

• Autoimmune conditions.

•  People with myasthenia gravis might be more likely to have autoimmune conditions, such as rheumatoid arthritis or lupus.


TREATMENT:-

• Mysthenia gravis is treated by administration of cholinesterase inhibitors such as neostigmine and pyridostigmine. 

• These drugs inhibit cholinesterase , which degrades acetylcholine. 

• So acetylcholine remaining in the synaptic cleft for long period can bind with its receptors.


PHYSIO THERAPY FOR MYSTHENIA GRAVIS:-

• Neurological Physiotherapy treatment will help a person with mysthenia gravis. 

• Physiotherapists understand that Myasthenia gravis can have a considerable impact you both physically and emotionally.

• Physiotherapy will help improve your energy levels and sense of well-being. The exercise program will depend on your individual needs and will be centred around:

• Increasing fitness and energy levels 


• Increasing muscle strength 


• Improving quality of sleep 


• Support with everyday tasks 


• Advice on diet 


• Improving posture when sitting, standing and sleeping 


• Increased ability to relax 


• Advice on supportive devices 


• Improving quality of life

• Muscle strength training to improve weakness in the muscles 


• Exercises to enhance functional abilities 


• Breathing control and assisted coughing if appropriate to maintain a clear chest. 


• Exercise to increase stamina and reduce fatigue 


• Relaxation therapy and massage to ease sore muscles. 


• Hydrotherapy


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