Myasthenia gravis history and symptoms: Difference between revisions

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==Overview==
==Overview==
History: Female Gender, african/Americans race, evidence of coexisting autoimmune diseases, a positive history of: Heavy [[Eyelid|eyelids]] and [[double vision]] , eye movement problems


==History==
[[Photophobia]] , facial weakness, [[tongue]] weakness, chewing and [[swallowing]] problems, respiratory problems, limbs muscles weakness, [[Fatigue]] and [[Urinary incontinence|urinary incontinency.]]<nowiki/>symptoms: Ptosis and diplopia, gaze paralysis, photophobia, facial weakness, orbicularis oculi weakness, tongue weakness (chewing problems and dysphagia), respiratory problems, limbs muscles weakness, fatigue and pelvic floor weakness.
A positive history of:


==Common symptoms==
== History and Symptoms ==


The hallmark of myasthenia gravis is Fluctuating [[weakness]] of specific [[Muscle|muscles]] in [[limbs]], [[bulbar]], [[ocular]] and [[respiratory system]] which get worse with activity or using the muscle.<ref name="pmid23117946">{{cite journal |vauthors=Silvestri NJ, Wolfe GI |title=Myasthenia gravis |journal=Semin Neurol |volume=32 |issue=3 |pages=215–26 |date=July 2012 |pmid=23117946 |doi=10.1055/s-0032-1329200 |url=}}</ref><ref name="pmid15052614">{{cite journal |vauthors=Keesey JC |title=Clinical evaluation and management of myasthenia gravis |journal=Muscle Nerve |volume=29 |issue=4 |pages=484–505 |date=April 2004 |pmid=15052614 |doi=10.1002/mus.20030 |url=}}</ref><ref name="pmid6951497">{{cite journal |vauthors=Keesey J, Buffkin D, Kebo D, Ho W, Herrmann C |title=Plasma exchange alone as therapy for myasthenia gravis |journal=Ann. N. Y. Acad. Sci. |volume=377 |issue= |pages=729–43 |date=1981 |pmid=6951497 |doi= |url=}}</ref>
===History===
*The important points in the history of a patient suspected for MG are:
**Age and Gender: The [[age of onset]] in Myasthenia gravis follows a bimodal distribution. The early type (before age of 50) is [[female]] predominant and the late type (after age of 60) is [[male]] predominant. Between the age of 50-60 there is no significant different between [[male]] and [[female]].<ref name="pmid23893883">{{cite journal |vauthors=Alkhawajah NM, Oger J |title=Late-onset myasthenia gravis: a review when incidence in older adults keeps increasing |journal=Muscle Nerve |volume=48 |issue=5 |pages=705–10 |date=November 2013 |pmid=23893883 |doi=10.1002/mus.23964 |url=}}</ref>
**Race: Some studies demonstrated that the [[incidence]], [[prevalence]] and the severity of this disease is higher in African/Americans.<ref name="pmid1407568">{{cite journal |vauthors=Phillips LH, Torner JC, Anderson MS, Cox GM |title=The epidemiology of myasthenia gravis in central and western Virginia |journal=Neurology |volume=42 |issue=10 |pages=1888–93 |date=October 1992 |pmid=1407568 |doi= |url=}}</ref><ref name="pmid19127534">{{cite journal |vauthors=Oh SJ, Morgan MB, Lu L, Hatanaka Y, Hemmi S, Young A, Claussen GC |title=Racial differences in myasthenia gravis in Alabama |journal=Muscle Nerve |volume=39 |issue=3 |pages=328–32 |date=March 2009 |pmid=19127534 |pmc=2814330 |doi=10.1002/mus.21191 |url=}}</ref>
**Evidence of coexisting autoimmune diseases<ref name="pmid12821744">{{cite journal |vauthors=Sanders DB, El-Salem K, Massey JM, McConville J, Vincent A |title=Clinical aspects of MuSK antibody positive seronegative MG |journal=Neurology |volume=60 |issue=12 |pages=1978–80 |date=June 2003 |pmid=12821744 |doi= |url=}}</ref>
*A positive history of:
** Heavy [[Eyelid|eyelids]] and [[double vision]] <ref name="pmid7369304">{{cite journal |vauthors=Osher RH, Glaser JS |title=Myasthenic sustained gaze fatigue |journal=Am. J. Ophthalmol. |volume=89 |issue=3 |pages=443–5 |date=March 1980 |pmid=7369304 |doi= |url=}}</ref>
** Eye movement problems <ref name="pmid570673">{{cite journal |vauthors=Spooner JW, Baloh RW |title=Eye movement fatigue in myasthenia gravis |journal=Neurology |volume=29 |issue=1 |pages=29–33 |date=January 1979 |pmid=570673 |doi= |url=}}</ref>
** [[Photophobia]] <ref name="pmid228589">{{cite journal |vauthors=Lepore FE, Sanborn GE, Slevin JT |title=Pupillary dysfunction in myasthenia gravis |journal=Ann. Neurol. |volume=6 |issue=1 |pages=29–33 |date=July 1979 |pmid=228589 |doi=10.1002/ana.410060107 |url=}}</ref>
** Facial weakness <ref name="pmid86952">{{cite journal |vauthors=Patten BM |title=Myasthenia gravis: review of diagnosis and management |journal=Muscle Nerve |volume=1 |issue=3 |pages=190–205 |date=1978 |pmid=86952 |doi=10.1002/mus.880010304 |url=}}</ref>
** [[Tongue]] weakness, chewing and [[swallowing]] problems <ref name="pmid7779022">{{cite journal |vauthors=De Assis JL, Marchiori PE, Scaff M |title=Atrophy of the tongue with persistent articulation disorder in myasthenia gravis: report of 10 patients |journal=Auris Nasus Larynx |volume=21 |issue=4 |pages=215–8 |date=1994 |pmid=7779022 |doi= |url=}}</ref><ref name="pmid4708458">{{cite journal |vauthors=Oosterhuis H, Bethlem J |title=Neurogenic muscle involvement in myasthenia gravis. A clinical and histopathological study |journal=J. Neurol. Neurosurg. Psychiatry |volume=36 |issue=2 |pages=244–54 |date=April 1973 |pmid=4708458 |pmc=1083560 |doi= |url=}}</ref>
** Respiratory problems <ref name="pmid12115943">{{cite journal |vauthors=Keesey JC |title="Crisis" in myasthenia gravis: an historical perspective |journal=Muscle Nerve |volume=26 |issue=1 |pages=1–3 |date=July 2002 |pmid=12115943 |doi=10.1002/mus.10095 |url=}}</ref><ref name="pmid10561522">{{cite journal |vauthors=Keesey JC |title=Does myasthenia gravis affect the brain? |journal=J. Neurol. Sci. |volume=170 |issue=2 |pages=77–89 |date=November 1999 |pmid=10561522 |doi= |url=}}</ref>
** Limbs muscles weakness <ref name="pmid6290881">{{cite journal |vauthors=Jablecki C, Benton A |title=The frequency of muscle involvement in myasthenia gravis correlates with mean muscle temperature |journal=Muscle Nerve |volume=5 |issue=6 |pages=491–2 |date=1982 |pmid=6290881 |doi= |url=}}</ref><ref name="pmid6287911">{{cite journal |vauthors=Engel AG, Lambert EH, Mulder DM, Torres CF, Sahashi K, Bertorini TE, Whitaker JN |title=A newly recognized congenital myasthenic syndrome attributed to a prolonged open time of the acetylcholine-induced ion channel |journal=Ann. Neurol. |volume=11 |issue=6 |pages=553–69 |date=June 1982 |pmid=6287911 |doi=10.1002/ana.410110603 |url=}}</ref><ref name="pmid1603341">{{cite journal |vauthors=Oh SJ, Kuruoglu R |title=Chronic limb-girdle myasthenia gravis |journal=Neurology |volume=42 |issue=6 |pages=1153–6 |date=June 1992 |pmid=1603341 |doi= |url=}}</ref><ref name="pmid10025802">{{cite journal |vauthors=Nations SP, Wolfe GI, Amato AA, Jackson CE, Bryan WW, Barohn RJ |title=Distal myasthenia gravis |journal=Neurology |volume=52 |issue=3 |pages=632–4 |date=February 1999 |pmid=10025802 |doi= |url=}}</ref>
** [[Fatigue]] <ref name="pmid9704288">{{cite journal |vauthors=Ochs CW, Bradley RJ, Katholi CR, Byl NN, Brown VM, Jones LL, Shohet JS |title=Symptoms of patients with myasthenia gravis receiving treatment |journal=J Med |volume=29 |issue=1-2 |pages=1–12 |date=1998 |pmid=9704288 |doi= |url=}}</ref>
** [[Urinary incontinence|Urinary incontinency]]<ref name="pmid4843338">{{cite journal |vauthors=Greene LF, Ghosh MK, Howard FM |title=Transurethral prostatic resection in patients with myasthenia gravis |journal=J. Urol. |volume=112 |issue=2 |pages=226–7 |date=August 1974 |pmid=4843338 |doi= |url=}}</ref><ref name="pmid6180793">{{cite journal |vauthors=Wise GJ, Gerstenfeld JN, Brunner N, Grob D |title=Urinary incontinence following prostatectomy in patients with myasthenia gravis |journal=Br J Urol |volume=54 |issue=4 |pages=369–71 |date=August 1982 |pmid=6180793 |doi= |url=}}</ref>


Symptoms of myasthenia gravis include:
* The importatnt point which we should keep in mind is that The hallmark of myasthenia gravis is Fluctuating [[weakness]] of specific [[Muscle|muscles]] in [[limbs]], [[bulbar]], [[ocular]] and [[respiratory system]] which get worse with activity or using the muscle.<ref name="pmid23117946">{{cite journal |vauthors=Silvestri NJ, Wolfe GI |title=Myasthenia gravis |journal=Semin Neurol |volume=32 |issue=3 |pages=215–26 |date=July 2012 |pmid=23117946 |doi=10.1055/s-0032-1329200 |url=}}</ref><ref name="pmid15052614">{{cite journal |vauthors=Keesey JC |title=Clinical evaluation and management of myasthenia gravis |journal=Muscle Nerve |volume=29 |issue=4 |pages=484–505 |date=April 2004 |pmid=15052614 |doi=10.1002/mus.20030 |url=}}</ref><ref name="pmid6951497">{{cite journal |vauthors=Keesey J, Buffkin D, Kebo D, Ho W, Herrmann C |title=Plasma exchange alone as therapy for myasthenia gravis |journal=Ann. N. Y. Acad. Sci. |volume=377 |issue= |pages=729–43 |date=1981 |pmid=6951497 |doi= |url=}}</ref>


===== ptosis and diplopia =====
===Common symptoms===
About 50 percent of patiens have [[ptosis]] and [[diplopia]] as their presenting sign. [[Ptosis]] is usually asymmetrical. The direction and degree of [[diplopia]] may change in a [[Myasthenia gravis|MG]] patients because of [[Fatigue|fatigable]] [[ocular]] motor [[paresis]].<ref name="pmid7369304">{{cite journal |vauthors=Osher RH, Glaser JS |title=Myasthenic sustained gaze fatigue |journal=Am. J. Ophthalmol. |volume=89 |issue=3 |pages=443–5 |date=March 1980 |pmid=7369304 |doi= |url=}}</ref>
*The hallmark of myasthenia gravis is Fluctuating [[weakness]] of specific [[Muscle|muscles]] in [[limbs]], [[bulbar]], [[ocular]] and [[respiratory system]] which get worse with activity or using the muscle.<ref name="pmid23117946">{{cite journal |vauthors=Silvestri NJ, Wolfe GI |title=Myasthenia gravis |journal=Semin Neurol |volume=32 |issue=3 |pages=215–26 |date=July 2012 |pmid=23117946 |doi=10.1055/s-0032-1329200 |url=}}</ref><ref name="pmid15052614">{{cite journal |vauthors=Keesey JC |title=Clinical evaluation and management of myasthenia gravis |journal=Muscle Nerve |volume=29 |issue=4 |pages=484–505 |date=April 2004 |pmid=15052614 |doi=10.1002/mus.20030 |url=}}</ref><ref name="pmid6951497">{{cite journal |vauthors=Keesey J, Buffkin D, Kebo D, Ho W, Herrmann C |title=Plasma exchange alone as therapy for myasthenia gravis |journal=Ann. N. Y. Acad. Sci. |volume=377 |issue= |pages=729–43 |date=1981 |pmid=6951497 |doi= |url=}}</ref>
*Symptoms of myasthenia gravis include:
* ptosis and diplopia
** About 50 percent of patiens have [[ptosis]] and [[diplopia]] as their presenting sign. [[Ptosis]] is usually asymmetrical. The direction and degree of [[diplopia]] may change in a [[Myasthenia gravis|MG]] patients because of [[Fatigue|fatigable]] [[ocular]] motor [[paresis]].<ref name="pmid7369304">{{cite journal |vauthors=Osher RH, Glaser JS |title=Myasthenic sustained gaze fatigue |journal=Am. J. Ophthalmol. |volume=89 |issue=3 |pages=443–5 |date=March 1980 |pmid=7369304 |doi= |url=}}</ref>
* Gaze paralysis
** The [[Ocular muscles|ocular muscle]] [[weakness]] in [[Myasthenia gravis|MG]] can cause [[Gaze palsy|gaze paralysis]] and even mimic [[internuclear ophthalmoplegia]] or midline [[brain]] lesions.<ref name="pmid570673">{{cite journal |vauthors=Spooner JW, Baloh RW |title=Eye movement fatigue in myasthenia gravis |journal=Neurology |volume=29 |issue=1 |pages=29–33 |date=January 1979 |pmid=570673 |doi= |url=}}</ref>
* Photophobia
** A lot of patients with myasthenia gravis complain that bright light bothers them and can even worsen the [[weakness]] of their [[eye muscles]]. Since this [[symptom]] is seen even in untreated patients, it’s not a complication of [[Anticholinesterase|anticholinesterases]] treatment.<ref name="pmid228589">{{cite journal |vauthors=Lepore FE, Sanborn GE, Slevin JT |title=Pupillary dysfunction in myasthenia gravis |journal=Ann. Neurol. |volume=6 |issue=1 |pages=29–33 |date=July 1979 |pmid=228589 |doi=10.1002/ana.410060107 |url=}}</ref>


===== Gaze paralysis =====
* Facial weakness
The [[Ocular muscles|ocular muscle]] [[weakness]] in [[Myasthenia gravis|MG]] can cause [[Gaze palsy|gaze paralysis]] and even mimic [[internuclear ophthalmoplegia]] or midline [[brain]] lesions.<ref name="pmid570673">{{cite journal |vauthors=Spooner JW, Baloh RW |title=Eye movement fatigue in myasthenia gravis |journal=Neurology |volume=29 |issue=1 |pages=29–33 |date=January 1979 |pmid=570673 |doi= |url=}}</ref>
** The [[facial]] [[weakness]] in [[Myasthenia gravis|MG]] occurs without [[sensation]] impairment of face. The [[sensation]] problems along with [[facial]] [[weakness]] suggest a different diagnosis like [[Nasopharyngeal carcinoma|nasopharyngeal carcinomas]].<ref name="pmid86952">{{cite journal |vauthors=Patten BM |title=Myasthenia gravis: review of diagnosis and management |journal=Muscle Nerve |volume=1 |issue=3 |pages=190–205 |date=1978 |pmid=86952 |doi=10.1002/mus.880010304 |url=}}</ref>


===== Photophobia =====
* Orbicularis oculi weakness
A lot of patients with myasthenia gravis complain that bright light bothers them and can even worsen the [[weakness]] of their [[eye muscles]]. Since this [[symptom]] is seen even in untreated patients, it’s not a complication of [[Anticholinesterase|anticholinesterases]] treatment.<ref name="pmid228589">{{cite journal |vauthors=Lepore FE, Sanborn GE, Slevin JT |title=Pupillary dysfunction in myasthenia gravis |journal=Ann. Neurol. |volume=6 |issue=1 |pages=29–33 |date=July 1979 |pmid=228589 |doi=10.1002/ana.410060107 |url=}}</ref>
** If we try to keep the [[upper eyelid]] of a [[Myasthenia gravis|MG]] patient open, they cannot close it against our force because of the weakness of [[orbicularis oculi muscle]].<ref name="pmid11781428">{{cite journal |vauthors=Roberts ME, Steiger MJ, Hart IK |title=Presentation of myasthenia gravis mimicking blepharospasm |journal=Neurology |volume=58 |issue=1 |pages=150–1 |date=January 2002 |pmid=11781428 |doi= |url=}}</ref>


===== Facial weakness =====
* tongue weakness, chewing problems and dysphagia
The [[facial]] [[weakness]] in [[Myasthenia gravis|MG]] occurs without [[sensation]] impairment of face. The [[sensation]] problems along with [[facial]] [[weakness]] suggest a different diagnosis like [[Nasopharyngeal carcinoma|nasopharyngeal carcinomas]].<ref name="pmid86952">{{cite journal |vauthors=Patten BM |title=Myasthenia gravis: review of diagnosis and management |journal=Muscle Nerve |volume=1 |issue=3 |pages=190–205 |date=1978 |pmid=86952 |doi=10.1002/mus.880010304 |url=}}</ref>
** The muscles of the [[tongue]] will become weak in [[Myasthenia gravis|MG]] patients especially after long speech. This can lead to unintelligible speech and [[dysphasia]]. Difficulty in [[swallowing]] can cause [[choking]] and nasal regurgitation. Furthermore the weakness of [[mastication]] muscles will cause chewing problem and can lead to weight loss.<ref name="pmid7779022">{{cite journal |vauthors=De Assis JL, Marchiori PE, Scaff M |title=Atrophy of the tongue with persistent articulation disorder in myasthenia gravis: report of 10 patients |journal=Auris Nasus Larynx |volume=21 |issue=4 |pages=215–8 |date=1994 |pmid=7779022 |doi= |url=}}</ref><ref name="pmid4708458">{{cite journal |vauthors=Oosterhuis H, Bethlem J |title=Neurogenic muscle involvement in myasthenia gravis. A clinical and histopathological study |journal=J. Neurol. Neurosurg. Psychiatry |volume=36 |issue=2 |pages=244–54 |date=April 1973 |pmid=4708458 |pmc=1083560 |doi= |url=}}</ref>


===== Orbicularis oculi weakness =====
* Respiratory problems
If we try to keep the [[upper eyelid]] of a [[Myasthenia gravis|MG]] patient open, they cannot close it against our force because of the weakness of [[orbicularis oculi muscle]].<ref name="pmid11781428">{{cite journal |vauthors=Roberts ME, Steiger MJ, Hart IK |title=Presentation of myasthenia gravis mimicking blepharospasm |journal=Neurology |volume=58 |issue=1 |pages=150–1 |date=January 2002 |pmid=11781428 |doi= |url=}}</ref>
** Inability to maintain a patent [[airway]] or respiratory insufficiency can occur in [[Myasthenia gravis|MG]] patients especially those who are in the [[Myasthenia gravis|MG]] crises.<ref name="pmid12115943">{{cite journal |vauthors=Keesey JC |title="Crisis" in myasthenia gravis: an historical perspective |journal=Muscle Nerve |volume=26 |issue=1 |pages=1–3 |date=July 2002 |pmid=12115943 |doi=10.1002/mus.10095 |url=}}</ref>
**Respiratory problems can cause inadequate [[sleep]] and day time [[somnolence]].<ref name="pmid10561522">{{cite journal |vauthors=Keesey JC |title=Does myasthenia gravis affect the brain? |journal=J. Neurol. Sci. |volume=170 |issue=2 |pages=77–89 |date=November 1999 |pmid=10561522 |doi= |url=}}</ref>


===== tongue weakness, chewing problems and dysphagia =====
* Limbs muscles weakness
The muscles of the [[tongue]] will become weak in [[Myasthenia gravis|MG]] patients especially after long speech. This can lead to unintelligible speech and [[dysphasia]]. Difficulty in [[swallowing]] can cause [[choking]] and nasal regurgitation. Furthermore the weakness of [[mastication]] muscles will cause chewing problem and can lead to weight loss.<ref name="pmid7779022">{{cite journal |vauthors=De Assis JL, Marchiori PE, Scaff M |title=Atrophy of the tongue with persistent articulation disorder in myasthenia gravis: report of 10 patients |journal=Auris Nasus Larynx |volume=21 |issue=4 |pages=215–8 |date=1994 |pmid=7779022 |doi= |url=}}</ref><ref name="pmid4708458">{{cite journal |vauthors=Oosterhuis H, Bethlem J |title=Neurogenic muscle involvement in myasthenia gravis. A clinical and histopathological study |journal=J. Neurol. Neurosurg. Psychiatry |volume=36 |issue=2 |pages=244–54 |date=April 1973 |pmid=4708458 |pmc=1083560 |doi= |url=}}</ref>
** Because the distal part of the [[limbs]] is warmer, they have less reserve of [[Acetylcholine|Ach]] and they will show more [[weakness]].<ref name="pmid6290881">{{cite journal |vauthors=Jablecki C, Benton A |title=The frequency of muscle involvement in myasthenia gravis correlates with mean muscle temperature |journal=Muscle Nerve |volume=5 |issue=6 |pages=491–2 |date=1982 |pmid=6290881 |doi= |url=}}</ref>
**The proximal muscles of [[upper extremities]] show [[weakness]] during hair brushing or dressing.<ref name="pmid6287911">{{cite journal |vauthors=Engel AG, Lambert EH, Mulder DM, Torres CF, Sahashi K, Bertorini TE, Whitaker JN |title=A newly recognized congenital myasthenic syndrome attributed to a prolonged open time of the acetylcholine-induced ion channel |journal=Ann. Neurol. |volume=11 |issue=6 |pages=553–69 |date=June 1982 |pmid=6287911 |doi=10.1002/ana.410110603 |url=}}</ref>
**The proximal muscles of [[lower extremities]] show [[weakness]] during walking up stair<ref name="pmid1603341">{{cite journal |vauthors=Oh SJ, Kuruoglu R |title=Chronic limb-girdle myasthenia gravis |journal=Neurology |volume=42 |issue=6 |pages=1153–6 |date=June 1992 |pmid=1603341 |doi= |url=}}</ref>  
**The distal muscle of [[limbs]] are more affected especially the finger [[extensors]].<ref name="pmid10025802">{{cite journal |vauthors=Nations SP, Wolfe GI, Amato AA, Jackson CE, Bryan WW, Barohn RJ |title=Distal myasthenia gravis |journal=Neurology |volume=52 |issue=3 |pages=632–4 |date=February 1999 |pmid=10025802 |doi= |url=}}</ref>


===== Respiratory problems =====
* Fatigue
Inability to maintain a patent [[airway]] or respiratory insufficiency can occur in [[Myasthenia gravis|MG]] patients especially those who are in the [[Myasthenia gravis|MG]] crises.<ref name="pmid12115943">{{cite journal |vauthors=Keesey JC |title="Crisis" in myasthenia gravis: an historical perspective |journal=Muscle Nerve |volume=26 |issue=1 |pages=1–3 |date=July 2002 |pmid=12115943 |doi=10.1002/mus.10095 |url=}}</ref> Respiratory problems can cause inadequate [[sleep]] and day time [[somnolence]].<ref name="pmid10561522">{{cite journal |vauthors=Keesey JC |title=Does myasthenia gravis affect the brain? |journal=J. Neurol. Sci. |volume=170 |issue=2 |pages=77–89 |date=November 1999 |pmid=10561522 |doi= |url=}}</ref>
**[[Myasthenia gravis|MG]] patients experience [[fatigue]] after a period of [[mental]] or physical activity.<ref name="pmid9704288">{{cite journal |vauthors=Ochs CW, Bradley RJ, Katholi CR, Byl NN, Brown VM, Jones LL, Shohet JS |title=Symptoms of patients with myasthenia gravis receiving treatment |journal=J Med |volume=29 |issue=1-2 |pages=1–12 |date=1998 |pmid=9704288 |doi= |url=}}</ref>


===== Limbs muscles weakness =====
=== Less common symptoms ===
Because the distal part of the [[limbs]] is warmer, they have less reserve of [[Acetylcholine|Ach]] and they will show more [[weakness]].<ref name="pmid6290881">{{cite journal |vauthors=Jablecki C, Benton A |title=The frequency of muscle involvement in myasthenia gravis correlates with mean muscle temperature |journal=Muscle Nerve |volume=5 |issue=6 |pages=491–2 |date=1982 |pmid=6290881 |doi= |url=}}</ref> The proximal muscles of [[upper extremities]] show [[weakness]] during hair brushing or dressing.<ref name="pmid6287911">{{cite journal |vauthors=Engel AG, Lambert EH, Mulder DM, Torres CF, Sahashi K, Bertorini TE, Whitaker JN |title=A newly recognized congenital myasthenic syndrome attributed to a prolonged open time of the acetylcholine-induced ion channel |journal=Ann. Neurol. |volume=11 |issue=6 |pages=553–69 |date=June 1982 |pmid=6287911 |doi=10.1002/ana.410110603 |url=}}</ref> The proximal muscles of [[lower extremities]] show [[weakness]] during walking up stair<ref name="pmid1603341">{{cite journal |vauthors=Oh SJ, Kuruoglu R |title=Chronic limb-girdle myasthenia gravis |journal=Neurology |volume=42 |issue=6 |pages=1153–6 |date=June 1992 |pmid=1603341 |doi= |url=}}</ref> The distal muscle of [[limbs]] are more affected especially the finger [[extensors]].<ref name="pmid10025802">{{cite journal |vauthors=Nations SP, Wolfe GI, Amato AA, Jackson CE, Bryan WW, Barohn RJ |title=Distal myasthenia gravis |journal=Neurology |volume=52 |issue=3 |pages=632–4 |date=February 1999 |pmid=10025802 |doi= |url=}}</ref> 
* Pelvic floor weakness
** The [[weakness]] of [[pelvic floor muscles]] leads to [[Urinary incontinence|urinary incontinency]] especially during [[cough]] or strain.<ref name="pmid4843338">{{cite journal |vauthors=Greene LF, Ghosh MK, Howard FM |title=Transurethral prostatic resection in patients with myasthenia gravis |journal=J. Urol. |volume=112 |issue=2 |pages=226–7 |date=August 1974 |pmid=4843338 |doi= |url=}}</ref><ref name="pmid6180793">{{cite journal |vauthors=Wise GJ, Gerstenfeld JN, Brunner N, Grob D |title=Urinary incontinence following prostatectomy in patients with myasthenia gravis |journal=Br J Urol |volume=54 |issue=4 |pages=369–71 |date=August 1982 |pmid=6180793 |doi= |url=}}</ref>


===== Fatigue =====
[[Myasthenia gravis|MG]] patients experience [[fatigue]] after a period of [[mental]] or physical activity.<ref name="pmid9704288">{{cite journal |vauthors=Ochs CW, Bradley RJ, Katholi CR, Byl NN, Brown VM, Jones LL, Shohet JS |title=Symptoms of patients with myasthenia gravis receiving treatment |journal=J Med |volume=29 |issue=1-2 |pages=1–12 |date=1998 |pmid=9704288 |doi= |url=}}</ref>
== Less common symptoms ==
===== Pelvic floor weakness =====
The [[weakness]] of [[pelvic floor muscles]] leads to [[Urinary incontinence|urinary incontinency]] especially during [[cough]] or strain.<ref name="pmid4843338">{{cite journal |vauthors=Greene LF, Ghosh MK, Howard FM |title=Transurethral prostatic resection in patients with myasthenia gravis |journal=J. Urol. |volume=112 |issue=2 |pages=226–7 |date=August 1974 |pmid=4843338 |doi= |url=}}</ref><ref name="pmid6180793">{{cite journal |vauthors=Wise GJ, Gerstenfeld JN, Brunner N, Grob D |title=Urinary incontinence following prostatectomy in patients with myasthenia gravis |journal=Br J Urol |volume=54 |issue=4 |pages=369–71 |date=August 1982 |pmid=6180793 |doi= |url=}}</ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

History: Female Gender, african/Americans race, evidence of coexisting autoimmune diseases, a positive history of: Heavy eyelids and double vision , eye movement problems

Photophobia , facial weakness, tongue weakness, chewing and swallowing problems, respiratory problems, limbs muscles weakness, Fatigue and urinary incontinency.symptoms: Ptosis and diplopia, gaze paralysis, photophobia, facial weakness, orbicularis oculi weakness, tongue weakness (chewing problems and dysphagia), respiratory problems, limbs muscles weakness, fatigue and pelvic floor weakness.

History and Symptoms

History

Common symptoms

  • tongue weakness, chewing problems and dysphagia
    • The muscles of the tongue will become weak in MG patients especially after long speech. This can lead to unintelligible speech and dysphasia. Difficulty in swallowing can cause choking and nasal regurgitation. Furthermore the weakness of mastication muscles will cause chewing problem and can lead to weight loss.[9][10]
  • Respiratory problems
    • Inability to maintain a patent airway or respiratory insufficiency can occur in MG patients especially those who are in the MG crises.[11]
    • Respiratory problems can cause inadequate sleep and day time somnolence.[12]

Less common symptoms

References

  1. ↑ Alkhawajah NM, Oger J (November 2013). "Late-onset myasthenia gravis: a review when incidence in older adults keeps increasing". Muscle Nerve. 48 (5): 705–10. doi:10.1002/mus.23964. PMID 23893883.
  2. ↑ Phillips LH, Torner JC, Anderson MS, Cox GM (October 1992). "The epidemiology of myasthenia gravis in central and western Virginia". Neurology. 42 (10): 1888–93. PMID 1407568.
  3. ↑ Oh SJ, Morgan MB, Lu L, Hatanaka Y, Hemmi S, Young A, Claussen GC (March 2009). "Racial differences in myasthenia gravis in Alabama". Muscle Nerve. 39 (3): 328–32. doi:10.1002/mus.21191. PMC 2814330. PMID 19127534.
  4. ↑ Sanders DB, El-Salem K, Massey JM, McConville J, Vincent A (June 2003). "Clinical aspects of MuSK antibody positive seronegative MG". Neurology. 60 (12): 1978–80. PMID 12821744.
  5. ↑ 5.0 5.1 Osher RH, Glaser JS (March 1980). "Myasthenic sustained gaze fatigue". Am. J. Ophthalmol. 89 (3): 443–5. PMID 7369304.
  6. ↑ 6.0 6.1 Spooner JW, Baloh RW (January 1979). "Eye movement fatigue in myasthenia gravis". Neurology. 29 (1): 29–33. PMID 570673.
  7. ↑ 7.0 7.1 Lepore FE, Sanborn GE, Slevin JT (July 1979). "Pupillary dysfunction in myasthenia gravis". Ann. Neurol. 6 (1): 29–33. doi:10.1002/ana.410060107. PMID 228589.
  8. ↑ 8.0 8.1 Patten BM (1978). "Myasthenia gravis: review of diagnosis and management". Muscle Nerve. 1 (3): 190–205. doi:10.1002/mus.880010304. PMID 86952.
  9. ↑ 9.0 9.1 De Assis JL, Marchiori PE, Scaff M (1994). "Atrophy of the tongue with persistent articulation disorder in myasthenia gravis: report of 10 patients". Auris Nasus Larynx. 21 (4): 215–8. PMID 7779022.
  10. ↑ 10.0 10.1 Oosterhuis H, Bethlem J (April 1973). "Neurogenic muscle involvement in myasthenia gravis. A clinical and histopathological study". J. Neurol. Neurosurg. Psychiatry. 36 (2): 244–54. PMC 1083560. PMID 4708458.
  11. ↑ 11.0 11.1 Keesey JC (July 2002). ""Crisis" in myasthenia gravis: an historical perspective". Muscle Nerve. 26 (1): 1–3. doi:10.1002/mus.10095. PMID 12115943.
  12. ↑ 12.0 12.1 Keesey JC (November 1999). "Does myasthenia gravis affect the brain?". J. Neurol. Sci. 170 (2): 77–89. PMID 10561522.
  13. ↑ 13.0 13.1 Jablecki C, Benton A (1982). "The frequency of muscle involvement in myasthenia gravis correlates with mean muscle temperature". Muscle Nerve. 5 (6): 491–2. PMID 6290881.
  14. ↑ 14.0 14.1 Engel AG, Lambert EH, Mulder DM, Torres CF, Sahashi K, Bertorini TE, Whitaker JN (June 1982). "A newly recognized congenital myasthenic syndrome attributed to a prolonged open time of the acetylcholine-induced ion channel". Ann. Neurol. 11 (6): 553–69. doi:10.1002/ana.410110603. PMID 6287911.
  15. ↑ 15.0 15.1 Oh SJ, Kuruoglu R (June 1992). "Chronic limb-girdle myasthenia gravis". Neurology. 42 (6): 1153–6. PMID 1603341.
  16. ↑ 16.0 16.1 Nations SP, Wolfe GI, Amato AA, Jackson CE, Bryan WW, Barohn RJ (February 1999). "Distal myasthenia gravis". Neurology. 52 (3): 632–4. PMID 10025802.
  17. ↑ 17.0 17.1 Ochs CW, Bradley RJ, Katholi CR, Byl NN, Brown VM, Jones LL, Shohet JS (1998). "Symptoms of patients with myasthenia gravis receiving treatment". J Med. 29 (1–2): 1–12. PMID 9704288.
  18. ↑ 18.0 18.1 Greene LF, Ghosh MK, Howard FM (August 1974). "Transurethral prostatic resection in patients with myasthenia gravis". J. Urol. 112 (2): 226–7. PMID 4843338.
  19. ↑ 19.0 19.1 Wise GJ, Gerstenfeld JN, Brunner N, Grob D (August 1982). "Urinary incontinence following prostatectomy in patients with myasthenia gravis". Br J Urol. 54 (4): 369–71. PMID 6180793.
  20. ↑ 20.0 20.1 Silvestri NJ, Wolfe GI (July 2012). "Myasthenia gravis". Semin Neurol. 32 (3): 215–26. doi:10.1055/s-0032-1329200. PMID 23117946.
  21. ↑ 21.0 21.1 Keesey JC (April 2004). "Clinical evaluation and management of myasthenia gravis". Muscle Nerve. 29 (4): 484–505. doi:10.1002/mus.20030. PMID 15052614.
  22. ↑ 22.0 22.1 Keesey J, Buffkin D, Kebo D, Ho W, Herrmann C (1981). "Plasma exchange alone as therapy for myasthenia gravis". Ann. N. Y. Acad. Sci. 377: 729–43. PMID 6951497.
  23. ↑ Roberts ME, Steiger MJ, Hart IK (January 2002). "Presentation of myasthenia gravis mimicking blepharospasm". Neurology. 58 (1): 150–1. PMID 11781428.

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