2. Assessment and Treatments

3.  History: weakness caused by any precipitating factors ( i.e. infection, emotional upset)  Time of weakness: after repeated muscle movement  Weakness improves with rest

4.  Muscles of facial expression affected  -ptosis  -chewing  -dysphagia  -speech  -vision

5.  Anticholinesterase agents (Mestinon,Regonol) -allows more acetycholine at the neuromuscular junction Side Effects: GI problems, bradycardia, bronchospasm, sweating IMPORTANT: Drugs must be given on time to maintain blood levels

6.  IV immunoglobulins (IVIg) sometimes given; affects function/production of abnormal antibodies  Side Effects: GI problems, diuresis  Cytotoxic Meds sometimes used  Corticosteroids (prednisone) -suppresses abnormal action of the immune system Side Effects: GI problems, HTN

7.  SEEN WITH UNDERMEDICATION  Stress may precipitate (infection)  Severe generalized weakness and respiratory failure  Patient needs ventilatory support, suctioning, Chest PT  Patient will need help with all ADL

8.  RESULT OF OVERMEDICATION WITH ANTICHOLINESTERASE DRUGS  Can mimic symptoms of myasthenic crisis  Differentiated via Tensilon test  Pt with Myasthenic Crisis will show immediate improvement following Tensilon administration  Pt with Anticholinergic Crisis will show no improvement and may get worse

9.  Magnesium  Morphine  Curare  Quinine  Quinidine  Procainamide  Hypnotics  sedatives  Antibiotics:  Neomycin  Kanamycin  Polymyxin B  Tetracyclines  Beta blockers

10.  PLASMAPHERESIS: plasma exchange ◦ Process removes abnormal antibodies from the plasma of the blood (short lived) ◦ Usually several treatments several days apart

11.  Thymectomy continues to be associated with improvement in 50-92% of patients  RESULT: ◦ Best response in young female w/ new dx ◦ Results in clinical improvement ◦ Decreases need for medication ◦ Approaches: -transthoracic -transcervical -endoscopic