Myasthenia Gravis: Etiology , Pathogenesis, Classification , Clinical features, Diagnosis, Treatment

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Myasthenia Gravis (MG) 💪🧠 -
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Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder characterized by weakness and rapid fatigue of voluntary muscles. It occurs due to the production of autoantibodies that target acetylcholine receptors (AChRs) at the neuromuscular junction, impairing the transmission of nerve impulses to muscles. In some cases, antibodies against muscle-specific kinase (MuSK) or lipoprotein-related protein 4 (LRP4) are also involved. This disruption leads to a decreased number of functional receptors, resulting in fluctuating muscle weakness that worsens with activity and improves with rest. 🦠⚡
Clinical Presentation: Common symptoms include ptosis (drooping of the eyelids), diplopia (double vision), dysarthria (difficulty speaking), dysphagia (difficulty swallowing), and generalized muscle weakness that affects activities such as chewing, breathing, and limb movement. The muscle weakness typically worsens towards the end of the day or after prolonged use.
Diagnosis: Diagnosis involves clinical evaluation, blood tests to detect anti-AChR or anti-MuSK antibodies, electromyography (EMG) to assess muscle function, and the edrophonium test, which temporarily improves muscle strength by inhibiting acetylcholinesterase. A CT or MRI scan may be performed to check for thymoma, a tumor of the thymus gland often associated with MG.
Management: Treatment aims to improve muscle function and reduce immune system activity against AChRs. Medications like acetylcholinesterase inhibitors (e.g., pyridostigmine) increase acetylcholine availability at the neuromuscular junction, enhancing muscle contraction. Immunosuppressive therapies, including corticosteroids, azathioprine, or mycophenolate, reduce the production of autoantibodies. In severe cases, plasmapheresis or intravenous immunoglobulin (IVIG) is used to rapidly decrease circulating antibodies. Thymectomy, the surgical removal of the thymus gland, may provide long-term benefits, especially in patients with thymoma.
Myasthenia Gravis can significantly impact quality of life, but with early diagnosis and appropriate management, many patients can achieve good control of symptoms and lead active lives.

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