Myasthenia gravis: Difference between revisions
From IDWiki
Content deleted Content added
Imported from text file |
No edit summary |
||
| (One intermediate revision by the same user not shown) | |||
| Line 4: | Line 4: | ||
* Can also present with predominantly bulbar involvement, or simple ocular involvement |
* Can also present with predominantly bulbar involvement, or simple ocular involvement |
||
== Clinical |
== Clinical Manifestations == |
||
* History |
* History |
||
| Line 20: | Line 20: | ||
*** Can approximate FVC by counting the duration of exhilation |
*** Can approximate FVC by counting the duration of exhilation |
||
* Chronic |
* Chronic |
||
=== Avoidance of Certain Medications === |
|||
* Some medications are thought to cause or exacerbate myasthenic crisis through a variety of mechanisms[[CiteRef::sheikh2021dr]] |
|||
* Altered immune response: |
|||
** Definite association with immune checkpoint inhibitors and [[D-penicillamine]] |
|||
** Probable association with [[statins]] |
|||
** Possible association with [[interferons]] |
|||
** Doubtful association with [[tandutinib]] |
|||
* Effects on neuromuscular transmission: |
|||
** Definite association with [[macrolides]], [[aminoglycosides]], class Ia antiarrhythmics, magnesium, neuromuscular blockers and inhaled anaesthetics, corticosteroids (use low doses when possible), botulinum toxin |
|||
** Probable association with [[fluoroquinolones]], [[penicillins]] (rare), [[lithium]] |
|||
** Possible association with beta blockers, L-type CCBs, antipsychotics |
|||
* The above antibiotics can be used if necessary, but may need close clinical monitoring |
|||
[[Category:Neurology]] |
[[Category:Neurology]] |
||
Latest revision as of 17:02, 17 February 2026
Definition
- A autoimmune disorder of the motor endplate that is associated with thymomas and causes a syndrome of weakness that worsens with repeated movements
- Can also present with predominantly bulbar involvement, or simple ocular involvement
Clinical Manifestations
- History
- Signs & Symptoms
- Ptosis worse than baseline
- Abnormal or fatiguable extraocular movements
- Dysarthria
- Neck flexion and extension (tests C3-4 that also innervates the diaphragm)
- Decreased duration of limb raiding
Management
- Acute
- Monitor FVC, MIPS, and MEPS
- Can approximate FVC by counting the duration of exhilation
- Monitor FVC, MIPS, and MEPS
- Chronic
Avoidance of Certain Medications
- Some medications are thought to cause or exacerbate myasthenic crisis through a variety of mechanisms1
- Altered immune response:
- Definite association with immune checkpoint inhibitors and D-penicillamine
- Probable association with statins
- Possible association with interferons
- Doubtful association with tandutinib
- Effects on neuromuscular transmission:
- Definite association with macrolides, aminoglycosides, class Ia antiarrhythmics, magnesium, neuromuscular blockers and inhaled anaesthetics, corticosteroids (use low doses when possible), botulinum toxin
- Probable association with fluoroquinolones, penicillins (rare), lithium
- Possible association with beta blockers, L-type CCBs, antipsychotics
- The above antibiotics can be used if necessary, but may need close clinical monitoring
References
- ^ Shuja Sheikh, Usman Alvi, Betty Soliven, Kourosh Rezania. Drugs That Induce or Cause Deterioration of Myasthenia Gravis: An Update. Journal of Clinical Medicine. 2021;10(7):1537. doi:10.3390/jcm10071537.
