PHARMACOLOGY

MYASTHENIA GRAVIS
DEFINITION

Myasthenia gravis is an autoimmune disorder affecting about 1

in 10,000 population due to development of IgG antibodies
against NM receptors at post synoptic NMJ
CLINICAL MANIFESTATIONS
1. Increased muscle weakness
2. Affected muscle are : muscle used for movement of eyes, chewing ,
swallowing , speaking and breathing .
3. In severe cases respiratory muscle weakness occur.
4. Ptosis
5. Diplopia
6. Extra ocular muscle weakness-ptosis in present initially in 50 % of patients
and during the course of disease in 90% of patients
DIAGNOSTIC TESTS
1. Demonstration of anti NR antibodies in plasma or muscle biopsy
specimen is more reliable test
2. CT scan for thymoma
3.  Edrophonium Test- to differentiate between due to myasthenia gravis or
cholinergic crisis 

Improvement-myasthenia gravis

Inject edrophonium-
                    [2mg i.v.]  
4. Provocative test-myasthenics are highly sensitive to d-
tubocurarine; 0.5mg i.v. causes marked weakness 
in them but is ineffective in non myasthenics.
 TREATMENT
     
1. Anti AchEs :
 (a). NEOSTIGMINE :
     Treatment start with Neostigmine  15mg orally 6 hours ; doses and frequency is then adjusted
according to response.

(b).PYRIDOSTIGMINE :
    It is an alternative which  needs less frequent dosing however it may not be
possible to restore muscle strength with achE alone.

2.corticosteroid-   
They inhibit production of NR- antibodies and may increase synthesis of NRs 
Prednisolone- 10 mg  daily on alternate days 
3. IMMUNOSUPPRESSANTS-
Azathioprine and cyclosporine inhibit NR-antibody synthesis by affecting T
cells.

4. THYMECTOMY-
Thymectomy means removal of thymus gland. In certain cases thymus gland
is removed which produces gradual improvement in majority cases. Thymus
contain modified muscle cells with NRs on their surface, which may be source
of antigen for production of anti-NR antibodies in myasthenic patients.  
5. PLASMAPHERESIS-
Plasmapheresis means plasma exchange . In this method, blood plasma from the
body is withdrawn, separating plasma and cells , and transfusing the cells back
into the blood stream.