Myasthenia gravis natural history, complications and prognosis: Difference between revisions

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==Natural History==
== Overview ==
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> 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 symptoms 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> Other signs and symptoms include: Gaze paralysis <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>, Orbicularis oculi weakness <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>, tongue weakness, chewing problems and dysphagia <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="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>, Pelvic floor weakness <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>.
Natural history: The [[age of onset]] before age of 50 is [[female]] predominant and after age of 60 is [[male]] predominant. Between the age of 50-60 there is no significant different between [[male]] and [[female]]. About 50 percent of patiens have [[ptosis]] and [[diplopia]] as their presenting sign. Complications: Complications from the treatment of myasthenia gravis such as: Glucocorticoids, azathioprine, cyclosporine, tacrolimus, cyclophosphamide, plasmapheresis, intravenous immune globulin and myasthenia crises (Respiratory failur). The [[prognosis]] of myasthenia gravis depends on: Disease duration at diagnosis, disease severity and the age of onset.  


In 15 percent of [[Myasthenia gravis|MG]] patients the [[Symptom|symptoms]] remain in the area of palpebrae superioris, [[orbicularis oculi]] and [[Oculomotor nerve|oculomotor]] muscles and other [[Symptom|symptoms]] of generalized disease doesn’t occur in them. This kind of myastehnia is [[Ocular myasthenia|OMG]] (ocular myasthenia gravis).(1-2-3-4-5-6 uptodate ocular)
== Natural History, Complications, and Prognosis ==


==Complications==
===Natural History===
* 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>
* 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 symptoms 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>
* Other signs and symptoms include: Gaze paralysis <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>, Orbicularis oculi weakness <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>, tongue weakness, chewing problems and dysphagia <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="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>, Pelvic floor weakness <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>.


==Prognosis==
* In 15 percent of [[Myasthenia gravis|MG]] patients the [[Symptom|symptoms]] remain in the area of palpebrae superioris, [[orbicularis oculi]] and [[Oculomotor nerve|oculomotor]] muscles and other [[Symptom|symptoms]] of generalized disease doesn’t occur in them. This kind of myastehnia is [[Ocular myasthenia|OMG]] (ocular myasthenia gravis).<ref name="pmid3318620">{{cite journal |vauthors=Grob D, Arsura EL, Brunner NG, Namba T |title=The course of myasthenia gravis and therapies affecting outcome |journal=Ann. N. Y. Acad. Sci. |volume=505 |issue= |pages=472–99 |date=1987 |pmid=3318620 |doi= |url=}}</ref><ref name="pmid6651238">{{cite journal |vauthors=Bever CT, Aquino AV, Penn AS, Lovelace RE, Rowland LP |title=Prognosis of ocular myasthenia |journal=Ann. Neurol. |volume=14 |issue=5 |pages=516–9 |date=November 1983 |pmid=6651238 |doi=10.1002/ana.410140504 |url=}}</ref><ref name="pmid1700335">{{cite journal |vauthors=Kaminski HJ, Maas E, Spiegel P, Ruff RL |title=Why are eye muscles frequently involved in myasthenia gravis? |journal=Neurology |volume=40 |issue=11 |pages=1663–9 |date=November 1990 |pmid=1700335 |doi= |url=}}</ref><ref name="pmid14592898">{{cite journal |vauthors=Kaminski HJ, Li Z, Richmonds C, Ruff RL, Kusner L |title=Susceptibility of ocular tissues to autoimmune diseases |journal=Ann. N. Y. Acad. Sci. |volume=998 |issue= |pages=362–74 |date=September 2003 |pmid=14592898 |doi= |url=}}</ref>
 
===Complications===
Complications that can develop as a result of myasthenia gravis are:
* Complications from the treatment of myasthenia gravis: the side effects of drugs we use in the treatment of myasthenia gravis can become very serious and reduce the quality of life in these patients:
** glucocorticoids: Skin thinning and [[purpura]]<ref name="pmid17501951">{{cite journal |vauthors=Fardet L, Flahault A, Kettaneh A, Tiev KP, Généreau T, Tolédano C, Lebbé C, Cabane J |title=Corticosteroid-induced clinical adverse events: frequency, risk factors and patient's opinion |journal=Br. J. Dermatol. |volume=157 |issue=1 |pages=142–8 |date=July 2007 |pmid=17501951 |doi=10.1111/j.1365-2133.2007.07950.x |url=}}</ref>, [[Cushingoid appearance]] and weight gain<ref name="pmid18684744">{{cite journal |vauthors=Huscher D, Thiele K, Gromnica-Ihle E, Hein G, Demary W, Dreher R, Zink A, Buttgereit F |title=Dose-related patterns of glucocorticoid-induced side effects |journal=Ann. Rheum. Dis. |volume=68 |issue=7 |pages=1119–24 |date=July 2009 |pmid=18684744 |doi=10.1136/ard.2008.092163 |url=}}</ref>, [[Cataract|cataracts]] and [[glaucoma]]<ref name="pmid16107513">{{cite journal |vauthors=Da Silva JA, Jacobs JW, Kirwan JR, Boers M, Saag KG, Inês LB, de Koning EJ, Buttgereit F, Cutolo M, Capell H, Rau R, Bijlsma JW |title=Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data |journal=Ann. Rheum. Dis. |volume=65 |issue=3 |pages=285–93 |date=March 2006 |pmid=16107513 |pmc=1798053 |doi=10.1136/ard.2005.038638 |url=}}</ref>, [[ischemic heart disease]] and [[heart failure]]<ref name="pmid15545676">{{cite journal |vauthors=Wei L, MacDonald TM, Walker BR |title=Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease |journal=Ann. Intern. Med. |volume=141 |issue=10 |pages=764–70 |date=November 2004 |pmid=15545676 |doi= |url=}}</ref>, [[gastritis]], ulcer formation, and [[gastrointestinal bleeding]]<ref name="pmid6343871">{{cite journal |vauthors=Messer J, Reitman D, Sacks HS, Smith H, Chalmers TC |title=Association of adrenocorticosteroid therapy and peptic-ulcer disease |journal=N. Engl. J. Med. |volume=309 |issue=1 |pages=21–4 |date=July 1983 |pmid=6343871 |doi=10.1056/NEJM198307073090105 |url=}}</ref>, [[Menstrual cycle|menstrual]] irregularities in women and low [[fertility]] in both men and women<ref name="pmid3083749">{{cite journal |vauthors=MacAdams MR, White RH, Chipps BE |title=Reduction of serum testosterone levels during chronic glucocorticoid therapy |journal=Ann. Intern. Med. |volume=104 |issue=5 |pages=648–51 |date=May 1986 |pmid=3083749 |doi= |url=}}</ref><ref name="pmid712726">{{cite journal |vauthors=Crilly R, Cawood M, Marshall DH, Nordin BE |title=Hormonal status in normal, osteoporotic and corticosteroid-treated postmenopausal women |journal=J R Soc Med |volume=71 |issue=10 |pages=733–6 |date=October 1978 |pmid=712726 |pmc=1436218 |doi= |url=}}</ref> and [[psychiatric]] and [[cognitive]] symptoms.<ref name="pmid19906230">{{cite journal |vauthors=Wolkowitz OM, Burke H, Epel ES, Reus VI |title=Glucocorticoids. Mood, memory, and mechanisms |journal=Ann. N. Y. Acad. Sci. |volume=1179 |issue= |pages=19–40 |date=October 2009 |pmid=19906230 |doi=10.1111/j.1749-6632.2009.04980.x |url=}}</ref>
** Azathioprine: [[macrocytosis]] (increased [[MCV]]) and [[Malignancy|malignancies]] such as [[Non hodgkin lymphoma|non-hodgkin lymphoma]].<ref name="pmid3762975">{{cite journal |vauthors=Witte AS, Cornblath DR, Schatz NJ, Lisak RP |title=Monitoring azathioprine therapy in myasthenia gravis |journal=Neurology |volume=36 |issue=11 |pages=1533–4 |date=November 1986 |pmid=3762975 |doi= |url=}}</ref><ref name="pmid10805346">{{cite journal |vauthors=Herrlinger U, Weller M, Dichgans J, Melms A |title=Association of primary central nervous system lymphoma with long-term azathioprine therapy for myasthenia gravis? |journal=Ann. Neurol. |volume=47 |issue=5 |pages=682–3 |date=May 2000 |pmid=10805346 |doi= |url=}}</ref>
** Cyclosporine: [[nephrotoxicity]]<ref name="pmid10676738">{{cite journal |vauthors=de Mattos AM, Olyaei AJ, Bennett WM |title=Nephrotoxicity of immunosuppressive drugs: long-term consequences and challenges for the future |journal=Am. J. Kidney Dis. |volume=35 |issue=2 |pages=333–46 |date=February 2000 |pmid=10676738 |doi= |url=}}</ref>, [[tremor]], [[nausea]], [[Myalgia|myalgias]], [[gingival hyperplasia]], [[hypertrichosis]] and [[Malignancy|malignancies]] such as [[squamous cell skin cancer]] and [[lymphoma]].<ref name="pmid10932288">{{cite journal |vauthors=Ciafaloni E, Nikhar NK, Massey JM, Sanders DB |title=Retrospective analysis of the use of cyclosporine in myasthenia gravis |journal=Neurology |volume=55 |issue=3 |pages=448–50 |date=August 2000 |pmid=10932288 |doi= |url=}}</ref>
** Tacrolimus: the side effects of this drug include [[hyperglycemia]], [[hypomagnesemia]], [[Paresthesia|paresthesias]] and [[tremor]].<ref name="pmid15883336">{{cite journal |vauthors=Ponseti JM, Azem J, Fort JM, López-Cano M, Vilallonga R, Buera M, Cervera C, Armengol M |title=Long-term results of tacrolimus in cyclosporine- and prednisone-dependent myasthenia gravis |journal=Neurology |volume=64 |issue=9 |pages=1641–3 |date=May 2005 |pmid=15883336 |doi=10.1212/01.WNL.0000160392.32894.6D |url=}}</ref>
** Cyclophosphamide: [[anorexia]], [[nausea and vomiting]], [[leukopenia]], [[alopecia]] and [[hemorrhagic cystitis]] and it can also increase the risk of [[Malignancy|malignancies]].<ref name="pmid3259286">{{cite journal |vauthors=McCune WJ, Golbus J, Zeldes W, Bohlke P, Dunne R, Fox DA |title=Clinical and immunologic effects of monthly administration of intravenous cyclophosphamide in severe systemic lupus erythematosus |journal=N. Engl. J. Med. |volume=318 |issue=22 |pages=1423–31 |date=June 1988 |pmid=3259286 |doi=10.1056/NEJM198806023182203 |url=}}</ref><ref name="pmid12115946">{{cite journal |vauthors=De Feo LG, Schottlender J, Martelli NA, Molfino NA |title=Use of intravenous pulsed cyclophosphamide in severe, generalized myasthenia gravis |journal=Muscle Nerve |volume=26 |issue=1 |pages=31–6 |date=July 2002 |pmid=12115946 |doi=10.1002/mus.10133 |url=}}</ref>
** plasmapheresis: [[infection]] and [[thrombosis]].<ref name="pmid7092611">{{cite journal |vauthors=Rodnitzky RL, Goeken JA |title=Complications of plasma exchange in neurological patients |journal=Arch. Neurol. |volume=39 |issue=6 |pages=350–4 |date=June 1982 |pmid=7092611 |doi= |url=}}</ref>
** intravenous immune globulin: [[headache]], [[dizziness]], [[chills]], [[fluid retention]], [[aseptic meningitis]], [[acute renal failure]], [[anaphylaxis]] and [[thrombosis]].<ref name="pmid10514226">{{cite journal |vauthors=Dalakas MC |title=Intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: present status and practical therapeutic guidelines |journal=Muscle Nerve |volume=22 |issue=11 |pages=1479–97 |date=November 1999 |pmid=10514226 |doi= |url=}}</ref><ref name="pmid15246245">{{cite journal |vauthors=Dalakas MC |title=The use of intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: evidence-based indications and safety profile |journal=Pharmacol. Ther. |volume=102 |issue=3 |pages=177–93 |date=June 2004 |pmid=15246245 |doi=10.1016/j.pharmthera.2004.04.002 |url=}}</ref>
 
* Myasthenia crises (Respiratory failur): because of [[respiratory]] muscle weakness, [[Myasthenia gravis|MG]] patients may experience crises in which the respiratory weakness is so severe that may result in [[intubation]].<ref name="pmid19078687">{{cite journal |vauthors=Bedlack RS, Sanders DB |title=On the concept of myasthenic crisis |journal=J Clin Neuromuscul Dis |volume=4 |issue=1 |pages=40–2 |date=September 2002 |pmid=19078687 |doi= |url=}}</ref>
* since the myasthenia is a chronic disease,most of the [[Complications]] that can develop as a result of this disease, may be equal to disease [[symptoms]].
 
===Prognosis===
The [[prognosis]] of myasthenia gravis depends on:
The [[prognosis]] of myasthenia gravis depends on:
* Disease duration at diagnosis: If the [[Symptom|symptoms]] last less than 1 year, the patient has a 25 percent chance of going into [[remission]] by 10 years.<ref name="pmid1802969" />
* Disease duration at diagnosis: If the [[Symptom|symptoms]] last less than 1 year, the patient has a 25 percent chance of going into [[remission]] by 10 years.<ref name="pmid1802969" />

Latest revision as of 14:34, 15 August 2019

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

Overview

Natural history: The age of onset before age of 50 is female predominant and after age of 60 is male predominant. Between the age of 50-60 there is no significant different between male and female. About 50 percent of patiens have ptosis and diplopia as their presenting sign. Complications: Complications from the treatment of myasthenia gravis such as: Glucocorticoids, azathioprine, cyclosporine, tacrolimus, cyclophosphamide, plasmapheresis, intravenous immune globulin and myasthenia crises (Respiratory failur). The prognosis of myasthenia gravis depends on: Disease duration at diagnosis, disease severity and the age of onset.

Natural History, Complications, and Prognosis

Natural History

Complications

Complications that can develop as a result of myasthenia gravis are:

  • Myasthenia crises (Respiratory failur): because of respiratory muscle weakness, MG patients may experience crises in which the respiratory weakness is so severe that may result in intubation.[42]
  • since the myasthenia is a chronic disease,most of the Complications that can develop as a result of this disease, may be equal to disease symptoms.

Prognosis

The prognosis of myasthenia gravis depends on:

  • Disease duration at diagnosis: If the symptoms last less than 1 year, the patient has a 25 percent chance of going into remission by 10 years.[43]
  • Disease severity[43]
  • The age of onset: Younger patients seems to have better chance for remission than older ones.[43] Patients more than 50 years old are more prone to myasthenia crises like respiratory failure.[21]

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. ↑ Osher RH, Glaser JS (March 1980). "Myasthenic sustained gaze fatigue". Am. J. Ophthalmol. 89 (3): 443–5. PMID 7369304.
  3. ↑ Silvestri NJ, Wolfe GI (July 2012). "Myasthenia gravis". Semin Neurol. 32 (3): 215–26. doi:10.1055/s-0032-1329200. PMID 23117946.
  4. ↑ Keesey JC (April 2004). "Clinical evaluation and management of myasthenia gravis". Muscle Nerve. 29 (4): 484–505. doi:10.1002/mus.20030. PMID 15052614.
  5. ↑ 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.
  6. ↑ Spooner JW, Baloh RW (January 1979). "Eye movement fatigue in myasthenia gravis". Neurology. 29 (1): 29–33. PMID 570673.
  7. ↑ 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. ↑ Patten BM (1978). "Myasthenia gravis: review of diagnosis and management". Muscle Nerve. 1 (3): 190–205. doi:10.1002/mus.880010304. PMID 86952.
  9. ↑ Roberts ME, Steiger MJ, Hart IK (January 2002). "Presentation of myasthenia gravis mimicking blepharospasm". Neurology. 58 (1): 150–1. PMID 11781428.
  10. ↑ 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.
  11. ↑ 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.
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  13. ↑ 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. ↑ 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. ↑ Oh SJ, Kuruoglu R (June 1992). "Chronic limb-girdle myasthenia gravis". Neurology. 42 (6): 1153–6. PMID 1603341.
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  21. ↑ 21.0 21.1 Bever CT, Aquino AV, Penn AS, Lovelace RE, Rowland LP (November 1983). "Prognosis of ocular myasthenia". Ann. Neurol. 14 (5): 516–9. doi:10.1002/ana.410140504. PMID 6651238.
  22. ↑ Kaminski HJ, Maas E, Spiegel P, Ruff RL (November 1990). "Why are eye muscles frequently involved in myasthenia gravis?". Neurology. 40 (11): 1663–9. PMID 1700335.
  23. ↑ Kaminski HJ, Li Z, Richmonds C, Ruff RL, Kusner L (September 2003). "Susceptibility of ocular tissues to autoimmune diseases". Ann. N. Y. Acad. Sci. 998: 362–74. PMID 14592898.
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  32. ↑ Witte AS, Cornblath DR, Schatz NJ, Lisak RP (November 1986). "Monitoring azathioprine therapy in myasthenia gravis". Neurology. 36 (11): 1533–4. PMID 3762975.
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  34. ↑ de Mattos AM, Olyaei AJ, Bennett WM (February 2000). "Nephrotoxicity of immunosuppressive drugs: long-term consequences and challenges for the future". Am. J. Kidney Dis. 35 (2): 333–46. PMID 10676738.
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  37. ↑ McCune WJ, Golbus J, Zeldes W, Bohlke P, Dunne R, Fox DA (June 1988). "Clinical and immunologic effects of monthly administration of intravenous cyclophosphamide in severe systemic lupus erythematosus". N. Engl. J. Med. 318 (22): 1423–31. doi:10.1056/NEJM198806023182203. PMID 3259286.
  38. ↑ De Feo LG, Schottlender J, Martelli NA, Molfino NA (July 2002). "Use of intravenous pulsed cyclophosphamide in severe, generalized myasthenia gravis". Muscle Nerve. 26 (1): 31–6. doi:10.1002/mus.10133. PMID 12115946.
  39. ↑ Rodnitzky RL, Goeken JA (June 1982). "Complications of plasma exchange in neurological patients". Arch. Neurol. 39 (6): 350–4. PMID 7092611.
  40. ↑ Dalakas MC (November 1999). "Intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: present status and practical therapeutic guidelines". Muscle Nerve. 22 (11): 1479–97. PMID 10514226.
  41. ↑ Dalakas MC (June 2004). "The use of intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: evidence-based indications and safety profile". Pharmacol. Ther. 102 (3): 177–93. doi:10.1016/j.pharmthera.2004.04.002. PMID 15246245.
  42. ↑ Bedlack RS, Sanders DB (September 2002). "On the concept of myasthenic crisis". J Clin Neuromuscul Dis. 4 (1): 40–2. PMID 19078687.
  43. ↑ 43.0 43.1 43.2 Beghi E, Antozzi C, Batocchi AP, Cornelio F, Cosi V, Evoli A, Lombardi M, Mantegazza R, Monticelli ML, Piccolo G (December 1991). "Prognosis of myasthenia gravis: a multicenter follow-up study of 844 patients". J. Neurol. Sci. 106 (2): 213–20. PMID 1802969.


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