main point is to suppress T cell function in order to control antibodies made against

acetylcholine receptors.

Thymectomy in myasthenia is like splenectomy in idiopathic

thrombocytopenic purpura. It markedly improves recurrent, hard-
to-control disease.

Management of Acute Myasthenic Crisis

Acute myasthenic crisis presents with severe, overwhelming disease with profound
weakness or respiratory involvement. It is treated with IVIG or plasmapheresis.

Dementia
Alzheimer’s disease is by far the most common cause of dementia. Since there is no
specific test for Alzheimer’s disease, your challenge is to know how far to go in testing
to diagnose it and what the other dementia syndromes are.

Figures 9.9, 9.10: Alzheimer’s disease, chronic alcoholism, and untreated HIV can all give diffuse symmetrical
atrophy (left). Draining a chronic subdural hematoma (right) may improve memory. This is a key reason why an MRI
of the head is done in dementia. Source: left: Pramod Theetha Kariyanna, MD. Source, right: Naveen Paddhu, MD.
Diagnostic Testing
• MRI of brain
• VDRL or RPR to exclude syphilis
• B12 with possible methylmalonic acid level
• Thyroid function test

Treatment
• Donepezil, rivastigmine, and galantamine are equal in efficacy. All increase
acetylcholine levels.
• Memantine

Lewy Body Dementia

• Associated with Parkinson’s disease
• Treat both Parkinson’s disease and Alzheimer’s disease with levodopa/carbidopa

Frontotemporal Dementia
• Emotional and social appropriateness are lost first
• Memory deteriorates later
• No special therapy beyond acetylcholine medications

Creutzfeldt-Jakob Disease
• Rapidly progressive dementia
• Myoclonic jerks
• Normal head MRI or CT
• CSF with 14-3-3 protein
• Biopsy is most accurate
• No specific therapy