Case Study Myasthenia Gravis

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Case Study 1: Ms. Lane – Myasthenia Gravis

CASE STUDY OF MYASTHENIA GRAVIS IN 35 YR OLD WORKING, INDEPENDENT, SINGLE MOTHER, PRESENTING WITH FATIGUE, AND ISSUES WITH FACIAL, AND EYE MUSCLES

INTRODUCTION Myasthenia Gravis, (MG), which means “grave muscle weakness” is a disorder classified as a chronic autoimmune neuromuscular disease (NINDS, 2010). This disease causes weakness in the muscles of the peripheral nervous system. The more frequently the muscle is used, the more likely it is to be affected. Thus, the first muscles affected are typically those involved in eye movements, facial expressions, talking, chewing and swallowing (Lundy-Ekman, 2007). MG is not contagious and with proper treatment has over a 90% survival rate (NINDS, 2010). It is possible that life expectancy can be affected if the muscles related to breathing are involved or if accidents occur because of vision or limb movement issues (Twork et al., 2010).
ETIOLOGY/PATHOLOGY
MG affects both male and females but more likely women under the under the age of 40 and men between the ages of 60-70 (Lundy-Ekman, 2007). The disorder is caused by an issue of communication at the neuromuscular junction. As electrical messages arrive in this junction, they release Acetylcholine to nerve receptors to control muscle contractions, whose actions trigger or suppress muscle movement. Patients with MG have a limited amount of these receptors because they are destroyed. The destruction is caused by antibodies that were made by the human body, intended to combat germs and infections (Lundy-Ekman, 2007 and NINDS, 2010). This disease is believed by many researches to have origin in the thymus. Some patients afflicted with MG have abnormal growth or tumors in this gland (Cavalcante et al., 2011).
DIAGNOSTIC TESTING Health practitioners will test for Myasthenia Gravis by first performing a medical history and physical examination. This may then progress to a neurological



References: Browning, J., Wallace, M., Chana, J., & Booth, J. (2011). Bedside testing for myasthenia gravis: The ice-test. Emergency Medicine Journal : EMJ, 28(8), 709-711. doi:10.1136/emj.06.2010.3091rep Cavalcante, P., Le Panse, R., Berrih-Aknin, S., Maggi, L., Antozzi, C., Baggi, F., et al. (2011). The thymus in myasthenia gravis: Site of "innate autoimmunity"? Muscle & Nerve, 44(4), 467-484. doi:10.1002/mus.22103; 10.1002/mus.22103 Cup, E. H., Pieterse, A. J., Ten Broek-Pastoor, J. M., Munneke, M., van Engelen, B. G., Hendricks, H. T., et al. (2007). Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: A systematic review. Archives of Physical Medicine and Rehabilitation, 88(11), 1452-1464. doi:10.1016/j.apmr.2007.07.024 Lundy-Ekman, L. (2007). Neuroscience: Fundamentals for Rehabilitation (Third Ed.). St. Louis, Missouri: Saunders Elsevier, p23f; 53-54, 68, 293 NINDS (2010): National Institute of Neurological Disorders and Stroke. NIH Publication No. 10-768. Last updated October 17, 2011 http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm. Twork S, Wiesmeth S, Klewer J, Phlau D, Kugler J, (2010) Quality of life and life circumstances in German myasthenia gravis patients. Health and quality of life outcomes. ", University of Technology Dresden, Germany. DOI: 10.1186/1477-7525-8-55

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