101. Myasthenia gravis.
- Author
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Gilhus NE, Tzartos S, Evoli A, Palace J, Burns TM, and Verschuuren JJGM
- Subjects
- Acetylcholinesterase genetics, Acetylcholinesterase physiology, Adrenal Cortex Hormones therapeutic use, Agrin genetics, Agrin physiology, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Autoantibodies analysis, Autoantibodies blood, Biomarkers analysis, Biomarkers blood, Blepharoptosis etiology, Collagen genetics, Collagen physiology, Cortactin genetics, Cortactin physiology, Electromyography methods, Humans, Kv1.4 Potassium Channel genetics, Kv1.4 Potassium Channel physiology, LDL-Receptor Related Proteins genetics, LDL-Receptor Related Proteins physiology, Muscle Proteins genetics, Muscle Proteins physiology, Myasthenia Gravis physiopathology, Receptor Protein-Tyrosine Kinases genetics, Receptor Protein-Tyrosine Kinases physiology, Receptors, Cholinergic genetics, Receptors, Cholinergic physiology, Receptors, Nicotinic genetics, Risk Factors, Ryanodine Receptor Calcium Release Channel genetics, Ryanodine Receptor Calcium Release Channel physiology, Myasthenia Gravis diagnosis, Myasthenia Gravis therapy
- Abstract
Myasthenia gravis (MG) is an autoimmune disease caused by antibodies against the acetylcholine receptor (AChR), muscle-specific kinase (MuSK) or other AChR-related proteins in the postsynaptic muscle membrane. Localized or general muscle weakness is the predominant symptom and is induced by the antibodies. Patients are grouped according to the presence of antibodies, symptoms, age at onset and thymus pathology. Diagnosis is straightforward in most patients with typical symptoms and a positive antibody test, although a detailed clinical and neurophysiological examination is important in antibody-negative patients. MG therapy should be ambitious and aim for clinical remission or only mild symptoms with near-normal function and quality of life. Treatment should be based on MG subgroup and includes symptomatic treatment using acetylcholinesterase inhibitors, thymectomy and immunotherapy. Intravenous immunoglobulin and plasma exchange are fast-acting treatments used for disease exacerbations, and intensive care is necessary during exacerbations with respiratory failure. Comorbidity is frequent, particularly in elderly patients. Active physical training should be encouraged.
- Published
- 2019
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