1. Myasthenia Gravis

2. 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.

3. 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.

4. 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)

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

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

7. 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.