Myasthenia Gravis

DEFINITION Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal muscles of the body. Cause: unknown but abnormal thymus gland Pathophysiology: Destruction of acetylcholine receptors at neuromuscular junction.

CLINICAL MANIFESTATIONS Ocular motor disturbances, ptosis or diplopia (90%) Oropharyngeal muscle weakness difficulty chewing tough,swallowing, or talking severity of weakness fluctuates during the day, No sensory or reflex loss; muscle atrophy is rare. Myaethenia Crisis: Myasthenic crisis is defined as respiratory muscle weakness that is severe enough to necessitate intubation or delay extubation.

Diagnostic studies Assessment: Have patient look up for 2-3 minutes; if affected by Myasthenia gravis , patient will have increased droop of eyelids. EMG may show muscle fatigue Tensilon test- in Myasthenia gravis reveal improved muscle contractility after edrophonium chloride (tensilon)

MEDICATION Surgery Anticholinesterase medications pyridostigmine immunosuppressive agents glucocorticoids, azathiopriane Plasmapheresis Surgery thymectomy

Physiotherapy assessment Demographic data - occupation Chief complain Cranial nerve examination Motor examination level of fatigue Functional test

Physical Therapy Intervention MG patients should find the optimal balance between physical activity and rest. To strengthen large muscle groups, particularly proximal muscles of shoulders and hips Advise patient to do the exercises at their "best time of day” (Mostly morning) If patient is taking pyridostigmine, exercise at peak dose ie. 1.5 to 2 hours after taking a dose Moderate intensity of exercise only: patient should not experience worsening of MG symptoms (eg. ptosis or diploplia) during exercise. General aerobic exercise is also valuable, helping with respiratory function as well endurance.