Abstract
A 57-year-male was admitted with difficulty in swallowing, breathing, and speaking for 2 months, which increased in the evenings. The onset was insidious and gradually progressive. Clinical examination revealed diplopia on horizontal gaze and wasting of muscles: intercostal, sternocleidomastoid, and flexors of the neck. There was no history of chest or cardiac disease and his oxygen saturation was low and respiratory rate was high. The patient was intubated and a nasogastric tube was inserted. He was started on high-dose methylprednisolone and tab pyridostigmine with other supportive measures. Serum acetylcholine receptor antibody was positive. MRI of the brain and CT of the chest were normal. After 7 days, tracheotomy and percutaneous endoscopic gastrostomy insertion were done. The patient gradually improved and was shifted to the ward. He was discharged in stable condition after 3 weeks of hospital admission with closed tracheostomy and in situ percutaneous endoscopic gastrostomy. He was on a tapering dose of steroid and pyridostigmine (60 mg 5 times daily) at first follow-up. Six months after admission his percutaneous endoscopic gastrostomy tube was removed.
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References
Hughes T. The early history of myasthenia gravis. Neuromuscul Disord. 2005;15:878–86.
Li Y, Arora Y, Levin K. Myasthenia gravis: newer therapies offer sustained improvement. Cleve Clin J Med. 2013;80(11):711–2.
Alkhawajah NM, Oger J. Late onset myasthenia gravis: a review when incidences in older adults keeps increasing. Muscle Nerve. 2013;48(5):705–10.
Juel VC, Massey JM. Myasthenia gravis. Orphanet J Rare Disord. 2007;2:44.
Namba T, Brunner NG, Grob D. Myasthenia gravis in patients with thymoma, with particular reference to onset after thymectomy. Medicine. 1978;57:411–33.
Sieb JP. Myasthenia gravis: an update for the clinician. Clin Exp Immunol. 2014;175:408–18.
Guptill JT, Sanders DB, Evoli A. Anti-MuSK antibody myasthenia gravis: clinical findings and response to treatment in two large cohorts. Muscle Nerve. 2011;44:36–40.
Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology. 2000;55:16–23.
Padua L, Stalberg E, LoMonaco M, Evoli A, Batocchi A, Tonali P. SFEMG in ocular myasthenia gravis diagnosis. Clin Neurophysiol. 2000;111:1203–7.
Hoch W, McConville J, Helms S, Newsom-Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med. 2001;7:365–8.
Higuchi O, Hamuro J, Motomura M, Yamanashi Y. Auto antibodies to low-density lipoprotein receptor-related protein 4 in myasthenia gravis. Ann Neurol. 2011;69:418–22.
Ropper AH, Samuels MA. Adams and Victor’s principles of neurology. 9th ed. New York: McGraw Hill; 2009. p. 1241–2.
Sarrigiannis PG, Kennett RP, Read S, Farrugia ME. Single fiber EMG with a concentric needle electrode validation in myasthenia gravis. Muscle Nerve. 2006;33:61–5.
Walker MB. Treatment of myasthenia gravis with physostigmine. Lancet. 1934;223:1200–1.
Saperstein DS, Barohn RJ. Management of myasthenia gravis. Semin Neurol. 2004;24:41–8.
Pascuzzi RM, Coslett HB, Johns TR. Long-term corticosteroid treatment of myasthenia gravis: report of 116 patients. Ann Neurol. 1984;15:291–8.
Simmons WD, Rayhill SC, Sollinger H. Preliminary risk-benefit assessment of mycophenolate mofetil in transplant rejection. Drug Saf. 1997;17:75–92.
Tandan R, Hehir MK 2nd, Waheed W, Howard DB. Rituximab treatment of myasthenia gravis: a systematic review. Muscle Nerve. 2017;56:185–96.
Dau PC, Lindstrom JM, Cassel CK, Denys EH, Shev EE, Spitler LE. Plasmapheresis and immunosuppressive drug therapy in myasthenia gravis. N Engl J Med. 1977;297:1134–40.
Gajdos P, Outin H, Elkharrat D, et al. High-dose intravenous gamma globulin for myasthenia gravis. Lancet. 1984;1:406–7.
Ipe TS, Davis AR, Raval JS. Therapeutic plasma exchange in myasthenia gravis: a systematic literature review and meta-analysis of comparative evidence. Front Neurol. 2021;12:662856.
Howard JF Jr, Barohn RJ, Cutter GR, Freimer M, Juel VC, Mozaffar T, MG Study Group, et al. A randomized, double-blind, placebo-controlled phase II study of eculizumab in patients with refractory generalized myasthenia gravis. Muscle Nerve. 2013;48:76–84.
Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016;87:419–25.
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Pokharel, B.R. (2024). Myasthenia Gravis. In: Oli, K.K., Shrestha, G.S., Ojha, R., Pal, P.K., Pandey, S., Das, B. (eds) Case-based Approach to Common Neurological Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-99-8676-7_17
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