Miastenia gravis

Question 1

Tratment

Answer 1

✔First line: cholinesterase inhibitors
Drug of choice: pyridostigmine!
Provides symptomatic relief
Side effects: see symptoms of cholinergic crisis
✔Supplemental immunosuppressants: if symptoms persist despite anticholinesterase treatment
Glucocorticoids👓
-Alternatives: azathioprine, cyclosporine, mycophenolate mofetil
Rapid immunomodulating therapies: in cases of myasthenic crisis
✔Thymectomy: can be beneficial even if a thymoma is not present!
Not for patients with MuSK antibody-associated MG without a thymoma

Question 2

Myasthenic crisis

During active phase!

Answer 2

1. Plasmapheresis
2. IV immune globulin

Affects 15–20% of patients with MG
Generally occurs during the active phase  within 5–7 years after onset
Acute, life-threatening exacerbation of myasthenic symptoms that leads to respiratory failure → early endotracheal intubation💥
-Potential triggers
Infection
Surgery, anesthesia
Pregnancy
Medications

Question 3

Cholinergic crisis

Answer 3

Myosis, bradycardia, fasciculation, skin warm and flushed with increased bronchial secretion

Durante una crisi miastenica invece è presente tachicardia!