Myasthenia Gravis
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.
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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.
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)
MEDICATION
• Anticholinesterase medications
– pyridostigmine
• immunosuppressive agents
– glucocorticoids, azathiopriane
• Plasmapheresis
Surgery
• thymectomy
Physiotherapy assessment
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Demographic data - occupation
Chief complain
Cranial nerve examination
Motor examination
level of fatigue
Functional test
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.