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MYASTHENIA GRAVIS
An autoimmune neuromuscular junction disorder caused by antibodies against nicotinic acetylcholine receptors β leads to fatigable muscle weakness.
Epidemiology
βοΈ Women: 20β30 yrs
βοΈ Men: 60β80 yrs
π§ ~75% have thymic abnormalities (hyperplasia > thymoma)
Key Clinical Features
βοΈ Fatigability: Weakness worsens with activity, improves with rest
βοΈ Commonly affected: ocular (ptosis, diplopia), facial, bulbar, neck & limb muscles
βοΈ No sensory loss or autonomic symptoms
βοΈ Reflexes: normal
Diagnosis
π§ͺ AChR antibodies (1st-line)
π§ͺ EMG β decremental response
π§ͺ Ice pack test βοΈ improves ptosis
π§ Chest CT/MRI to rule out thymoma
π Edrophonium test = short-lived improvement
Management
1οΈβ£ Crisis: Plasmapheresis / IVIG + steroids
2οΈβ£ Chronic: Pyridostigmine (Β± glycopyrrolate) β add steroids β transition to azathioprine
3οΈβ£ Surgery: Thymectomy if thymoma or age <60 with mild-moderate disease
βββββββββ-
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