PERIPHERAL

AND
SPINAL MOVEMENT
DISORDERS

ALMAZ SAHANA IQBAL

 MYASTHENIA GRAVIS (MG) IS AN AUTOIMMUNE

DISORDER AFFECTING THE NEUROMUSCULAR

JUNCTION. IT IS A RELATIVELY RARE, LONG TERM

CONDITION CAUSED BY CIRCULATING ANTIBODIES

THAT BLOCK ACETYLCHOLINE RECEPTORS AT THE

POSTSYNAPTIC NEUROMUSCULAR JUNCTION,

INHIBITING THE EXCITATORY EFFECTS OF THE

NEUROTRANSMITTER ACETYLCHOLINE. MG AFFECTS

PEOPLE AT ANY AGE BUT IT COMMONLY TO AFFECTS

WOMEN UNDER 40.

 “IT IS A FLUCTUATING WEAKNESS
OF CERTAIN VOLUNTARY MUSCLES,
PARTICULARLY THOSE INNERVATED
BY MOTOR NUCLEI OF THE
BRAINSTEM, I.E. OCULAR,
MASTICATORY, FACIAL,
DEGLUTITIONAL, AND LINGUAL”.
SYMPTOMS
THE WEAKNESS RESULTS NOT FROM DAMAGE
TO, OR LOSS OF TISSUE FROM, THE MUSCLES
THEMSELVES, BUT FROM IMPAIRED NEURO-
MUSCULAR SYNAPTIC TRANSMISSION.

IN MOST CASES, NORMAL AMOUNTS OF THE

NEUROTRANSMITTER ACETYLCHOLINE (ACH)
ARE RELEASED FROM MOTOR NEURONS BUT
THIS FAILS TO HAVE THE EXPECTED EFFECT
ON THE TARGET MUSCLES.
 IN THE 1970S IT BECAME APPARENT THAT MYASTHENIC
INDIVIDUALS HAVE A REDUCED NUMBER OF ACH RECEPTORS
(ALBUQUERQUE ET AL., 1976), WHICH IS THOUGHT TO OCCUR
AS A RESULT OF AN INAPPROPRIATE IMMUNE RESPONSE IN
WHICH (FOR REASONS THAT ARE NOT CURRENTLY KNOWN)
THE BODY’S IMMUNE SYSTEM INADVERTENTLY ATTACKS ACH
RECEPTORS AS IF THEY WERE ‘FOREIGN’. MYASTHENIA
GRAVIS THEREFORE JOINS A GROWING LIST OF AUTO-
IMMUNE DISEASES (ENGEL, 1984).
The drugs in question
achieve this by
inhibiting the enzyme
that normally breaks
down ACH soon
after it is released.
The enzyme is
acetylcholine
esterase (ACHE) and
the drugs are
therefore known as
acetylcholine
esterase inhibitors
(ACHEIs).
 Examples include

physostigmine and

neostigmine. These medications

are, however, far from ideal,

Physostigmine because they influence all ACH

synapses including many in the

Neostigmine brain, where they may induce a

raft of unwanted side effects

including sleep disturbances,

cognitive impairments and

hallucinations.
REFERENCE
https://file:///C:/Users/Almaz%20Sahana%2
0Iqbal/Downloads/Introducing%20Neurops
ychology-Stirling.pdf
Stirling, J. D. (2002). Introducing
neuropsychology. Psychology Press.
 ALMAZ SAHANA
IQBAL

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