MYASTHENIA GRAVIS is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary)

muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." With current therapies, however, most cases of myasthenia gravis are not as "grave" as the name implies. In fact, most individuals with myasthenia gravis have a normal life expectancy.
anticholinesterase agents such as neostigmine and pyridostigmine, --help improve neuromuscular transmission and increase muscle strength. Immunosuppressive drugs such as prednisone, azathioprine, cyclosporin, mycophenolate mofetil, and tacrolimus-improve muscle strength by suppressing the production of abnormal antibodies.

Motor nerve impulses travel to nerve terminal

Ach is released

The health care provider performs a physical exam, including a detailed nervous system (neurological) examination. This may show: Muscle weakness - eye muscles are usually affected first Reflexes and feeling (sensation) are normal. Tests that may be done may include: Acetylcholine receptor antibodies associated with this disease CT or MRI scan of the chest to look for a tumor Nerve conduction studies: edrophonium test
EMG

Ach diffuses across synapse

Ach receptor sites, weakened/destroyed by attached antibodies, block Ach receptors

Depolarization and muscle contraction dont occur. Neuromuscular transmission is blocked

Thymectomy, the surgical removal of the thymus gland (which often is abnormal in individuals with myasthenia gravis), reduces symptoms in some individuals without thymoma and may cure some people, possibly by re-balancing the immune system.

plasmapheresis, a procedure in which serum containing the abnormal antibodies is removed from the blood while cells are replaced, and highdose intravenous immune globulin, which temporarily modifies the immune system by infusing antibodies from donated blood.

1. Establish accurate neurologic and respiratory baseline. 2. Listen to the patients concerns and answer the questions honestly. 3. Administer medications on time and at evenly spaced intervals, as ordered, to prevent relapses. 4. Plan exercise, meals, patient care, and activities to make the most of energy peaks. 5. When swallowing is difficult, give semi-solid foods instead of liquids to lessen the risk of choking.
6. An eye patch if double vision is bothersome

7. After severe exacerbations, try to increase social activity as soon as possible. 8. Stay alert for signs of impending myesthenic crisis such as increased muscle weakness and difficulty talking or chewing. 9. Help the patient plan daily activities to coincide with energy peaks. 10. Stress the need for frequent rest periods. 11. If surgery is scheduled, provide perioperative teaching.

Breathing difficulty because of weakness of the chest wall muscles Chewing or swallowing difficulty, causing frequent gagging, choking, or drooling Difficulty climbing stairs, lifting objects, or rising from a seated position Difficulty talking Drooping head Facial paralysis or weakness of the facial muscles Fatigue Hoarseness or changing voice Double vision Difficulty maintaining steady gaze Eyelid drooping