A Simple Guide to Myasthenia Gravis (Updated), Diagnosis, Treatment and Related Conditions

By Kenneth Kee

This book describes Myasthenia Gravis (Updated), Diagnosis and Treatment and Related Diseases

The knowledge of myasthenia gravis has greatly increased in recent years.

1. The antibody reaction in seronegative disease is now better featured with recognition of extra targets of antibody attack, such as MuSK.

2. In a recent study, an improved diagnostic sensitivity was obtained using anti-AChR ε subunit specific antibodies compared with the conventional AChR antibody testing.

3. Fab fragments of monoclonal antibodies directed against the main immunogenic region of the acetylcholine receptor have been proven to be effective in the prevention of passively transferred experimental autoimmune myasthenia gravis.

4. Photopheresis with blood lymphocytes exposed to ultraviolet radiation was proven to have a more prolonged remission than the conservative plasmapheresis in a recent study.

5. Mycophenolate mofetil is an immunosuppressive agent produced and initially used to prevent acute rejection of solid organ transplantation.

6. Recently, computed tomography guided percutaneous ethanol injection into the thymus has been proven to be effective, minimally invasive, and safe in the treatment of myasthenia gravis.

7. Specifically, the purpose of treatment should be to eradicate the autoimmune reaction to AChR particularly, without otherwise interfering with the immune system.

8. Myasthenia gravis is an autoimmune disorder featured by the weakness and fatigability of the voluntary muscles that is produced by auto-antibodies against the nicotinic AChR on the postsynaptic membrane at the neuromuscular junction.

9. It is almost always possible to confirm the diagnosis of myasthenia gravis with the present tests.

10. Modern treatment is highly effective and mortality of treated disease is almost zero.

11. Argenx, a Belgian drug maker, recently informed a successful phase 3 ADAPT trial of its experimental drug, efgartigimod.

12. In a global study of myasthenia gravis, an autoimmune disease that causes muscle weakness and fatigue, doctors found that surgical removal of an organ called the thymus (thymectomy) decreased patients' weakness, and their need for immunosuppressive drugs.

Myasthenia gravis is a rare chronic autoimmune neuromuscular disease
This condition occurs more in women than men at any age
Myasthenia gravis literally means grave muscle weakness.
Antibodies blocks the neurotransmitter junction, causing a neuromuscular illness

The thymus gland may give incorrect instructions to developing immunity
This results in the production of the acetylcholine receptor antibodies.
Which unfortunately block the receptors at the neuromuscular junction
This result in the receptors unable to generate a muscle contraction

The muscle weakness usually increases during periods of activity
There is weakness of the eye, neck, limbs and fatigue
There is slurred speech and difficulty in swallowing
There may a waddling gait and difficulty in breathing

Treatment for myasthenia gravis is with anticholinesterase agents such as neostigmine
Immunosuppressive drugs such as prednisone, cyclosporine, and azathioprine
Thymectomy reduces symptoms in more than 70 percent of patients surgically
Plasmapheresis in which intravenous immune globulin replaces the abnormal antibodies

-An original poem by Kenneth Kee

TABLE OF CONTENT
Introduction
Chapter 1 Myasthenia Gravis
(Updated)
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Motor Neuron Disease
Chapter 8 Multiple Sclerosis
Epilogue

• Language: English
• Publisher: Kenneth Kee
• Release date: Jun 16, 2021
• ISBN: 9781005272593

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

A

Simple

Guide

To

Myasthenia Gravis (Updated),

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2021 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Myasthenia Gravis (Updated), Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Myasthenia Gravis)

This e-Book is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiography account of my journey as a medical student to family doctor on my other blog: http://afamilydoctorstale.blogspot.com.

This autobiography account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

My diagnosis and treatment capability has improved tremendously from my continued education.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Myasthenia Gravis (Updated)

The knowledge of myasthenia gravis has greatly increased in recent years.

1. The antibody reaction in seronegative disease is now better featured with recognition of extra targets of antibody attack, such as MuSK.

An increased understanding of the molecular structure of the AChR has helped develop antibodies against its personal subunits for diagnostic and therapeutic purposes.

2. In a recent study, an improved diagnostic sensitivity was obtained using anti-AChR ε subunit specific antibodies compared with the conventional AChR antibody testing.

3. Fab fragments of monoclonal antibodies directed against the main immunogenic region of the acetylcholine receptor have been proven to be effective in the prevention of passively transferred experimental autoimmune myasthenia gravis.

4. Photopheresis with blood lymphocytes exposed to ultraviolet radiation was proven to have a more prolonged remission than the conservative plasmapheresis in a recent study.

5. Mycophenolate mofetil is an immunosuppressive agent produced and initially used to prevent acute rejection of solid organ transplantation.

In a placebo controlled study in the treatment of poorly controlled, stable myasthenia gravis, there is a greater improvement in the patients receiving mycophenolate mofetil compared with placebo.

This medicine has a much better safety profile than the other immunosuppressive agents.

6. Recently, computed tomography guided percutaneous ethanol injection into the thymus has been proven to be effective, minimally invasive, and safe in the treatment of myasthenia gravis.

7. Specifically, the purpose of treatment should be to eradicate the autoimmune reaction to AChR particularly, without otherwise interfering with the immune system. This is not yet achieved.

8. Myasthenia gravis is an autoimmune disorder featured by the weakness and fatigability of the voluntary muscles that is produced by auto-antibodies against the nicotinic AChR on the postsynaptic membrane at the neuromuscular junction.

The understanding of the pathogenesis, immunology, and molecular biology of myasthenia gravis has greatly increased in the last three decades.

9. It is almost always possible to confirm the diagnosis of myasthenia gravis with the present tests.

10. Modern treatment is highly effective and mortality of treated disease is almost zero.

There are still important gaps in the knowledge of the source of myasthenia gravis, the factors that contribute to chronic disease, and the way to cure the disease

11. Argenx, a Belgian drug maker, recently informed a successful phase 3 ADAPT trial of its experimental drug, efgartigimod.

Argenx plans to seek USA. approval of the drug by the end of year 2021 as a possible new treatment for patients with generalized myasthenia gravis (gMG), a rare and chronic autoimmune disease where communication between nerves and muscles is disrupted, producing debilitating muscle weakness.

12. In a global study of myasthenia gravis, an autoimmune disease that causes muscle weakness and fatigue, doctors found that surgical removal of an organ called the thymus (thymectomy) decreased patients' weakness, and their need for immunosuppressive drugs.

Myasthenia Gravis

(Chapter from A Simple Guide to Myasthenia Gravis 2014 by Kenneth Kee)

Myasthenia gravis is a rare chronic autoimmune neuromuscular disease

This condition occurs more in women than men at any age

Myasthenia gravis literally means grave muscle weakness.

Antibodies blocks the neurotransmitter junction, causing a neuromuscular illness

The thymus gland may give incorrect instructions to developing immunity

This results in the production of the acetylcholine receptor antibodies.

Which unfortunately block the receptors at the neuromuscular junction

This result in the receptors unable to generate a muscle contraction

The muscle weakness usually increases during periods of activity

There is weakness of the eye, neck, limbs and fatigue

There is slurred speech and difficulty in swallowing

There may a waddling gait and difficulty in breathing

Treatment for myasthenia gravis is with anticholinesterase agents such as neostigmine

Immunosuppressive drugs such as prednisone, cyclosporine, and azathioprine

Thymectomy reduces symptoms in more than 70 percent of patients surgically

Plasmapheresis in which intravenous immune globulin replaces the abnormal antibodies

-An original poem by Kenneth Kee

What is Myasthenia gravis?

Myasthenia gravis is a rare chronic autoimmune neuromuscular disease that produces weakening of the skeletal muscles of the body.

The name myasthenia gravis literally indicates grave muscle weakness.

Myasthenia gravis (MG) is the most frequent disorder affecting the neuromuscular junction (NMJ) of the skeletal muscles.

The classic manifestation is a fluctuating weakness that is more prominent in the afternoon.

It normally involves muscles of the eyes, throat, and extremities.

The decreased transmission of electrical impulses across the neuromuscular junction due to the formation of auto-antibodies against the specific postsynaptic membrane proteins subsequently induces muscle weakness.

A wide range of disorders can trigger MG, such as infections, immunization, surgeries, and drugs.

Myasthenia gravis causes a significant number of complications.

These are:

1. Myasthenic crisis, an acute respiratory paralysis that requires intensive care, and

2. Adverse events due to long term medication treatment like opportunistic infections and lymphoproliferative malignancies.

Myasthenia Gravis Classification

Depending on the type of medical features and the type of antibodies affected, MG can be classified into different subgroups.

Each group reacts differently to treatment and hence brings a prognostic value:

1. Early-onset MG: age at onset less than 50 years with thymus gland hyperplasia

2. Late-onset MG: age at onset greater than 50 years with thymus gland atrophy

3. Thymoma-associated MG

4. MG with anti-MuSK antibodies

5. Ocular MG: symptoms only from periocular muscles

6. MG with no detectable AChR and MuSK antibodies

What are the causes of Myasthenia Gravis?

Causes

Myasthenia gravis, like autoimmune disorders, happens in genetically susceptible persons.

Precipitating factors are conditions like:

1. Infections,

3. Immunization,

3. Surgeries, and

4. Drugs.

The often implicated proteins in the NMJ against which auto-antibodies are produced are:

1. The nicotinic acetylcholine receptors (n-AChR's),

2. Muscle-specific kinase (MuSK), and

3. Lipoprotein-related protein 4 (LPR4).

Agrin–LRP4–MuSK protein complex is necessary for the formation and maintenance of NMJ, such as the distribution and clustering of the AChR.

10% of patients with MG