1.What is myasthenia gravis?
Myasthenia gravis (MG) is an acquired autoimmune disease caused by dysfunction of neuromuscular junction transmission. The lesion is located in the postsynaptic membrane of the neuromuscular junction, and the acetylcholine receptor (AchR) on this membrane is damaged, and the number of receptors is reduced. The main clinical manifestations are partial or generalized skeletal muscle weakness and easy fatigue, and the symptoms are aggravated after activity, and after rest and application of cholinesterase inhibitor treatment Symptoms are reduced after rest and treatment with cholinesterase inhibitors. The incidence of myasthenia gravis is (0.5-5)/100,000, and the prevalence is 10/100,000.
2. Which age group is the peak of myasthenia gravis incidence?
Myasthenia gravis has two peak ages of onset: 20-40 years old and 40-60 years old, with the first age group being more prevalent in women and the second age group being more prevalent in men.
3.What are the causes of myasthenia gravis?
There are two major categories of causes of myasthenia gravis.
(1) The first category is congenital heredity, which is extremely rare and not related to autoimmunity.
(2) The second category is autoimmune diseases, which are the most common. The cause of the disease is still unclear, and it is generally believed to be related to infections, drugs, and environmental factors. Meanwhile, 65% to 80% of patients with myasthenia gravis have thymic hyperplasia and 10% to 20% have thymoma.
4.What are the predisposing factors of myasthenia gravis?
(1) Environmental factors: certain environmental factors, including chemical plants, heavy metal production sites, dust and noise, etc., environmental pollution caused by the decline in immunity and easy to trigger the occurrence of myasthenia gravis.
(2) Food contamination and poisoning: It is the main cause of myasthenia gravis, and a significant proportion of patients develop the disease by eating fries fried in unclean cooking oil and poor quality drinks contaminated by chemicals.
(3) Nutritional factors: many patients have poor family conditions, more patients from abroad and fewer patients from Beijing, which may be related to long-term nutritional deficiency and strain.
(4) Mental tension, overwork: some patients with myasthenia gravis often develop the disease after long hours of playing mahjong and computer games, so it is necessary to combine work and rest and keep a relaxed mood.
5.What are the early symptoms of myasthenia gravis?
(1) General weakness: From the outside, the skin looks good, and there is no muscle atrophy, as if there is no disease; however, the patient often feels severe general weakness, unable to lift the shoulder, unable to lift the hand, unable to stand up when squatting, and even relying on others to help wash the face and comb the hair. The patient’s muscle weakness symptoms improve significantly after resting for a while, and then worsen significantly with a little work. Most of these patients also have symptoms such as droopy eyelids and diplopia.
(2) Droopy eyelids: Also known as droopy eyelids, droopy eyelids are reported to be the first symptom in up to 73% of patients, and can be seen at any age, especially in children.
(3) Diplopia: This is double vision. If you look with both eyes together, you see one thing as two; if you cover one eye, you see one. Very young children do not describe diplopia and often compensate by tilting their heads and necks in order to make diplopia disappear and see clearly, and in severe cases, they may also show strabismus.
(4) Dysphagia: There is no digestive tract disease, and the appetite is quite good, but good food is not swallowed, and even water is not swallowed. When drinking water, it either chokes into the trachea and causes coughing, or flows out of the nostrils. Some patients have to rely on the nasal feeding tube to eat due to severe swallowing difficulties.
(5) Weakness in chewing: The teeth are fine, but there is no strength to bite things, and even biting buns is hard. The first few bites are okay, but the more you bite, the less you can bite. It is even more difficult to eat pancakes and roast meat.
(6) Hoarseness: It is like having a cold or flu. Some patients speak at meetings or read the newspaper, the first few minutes the voice can be, a little longer, the voice becomes hoarse, low, and finally completely unable to make a sound. When talking on the phone at first, it is okay, but after a long time, others can not hear what he said. This is due to the weakness of the pharyngeal muscles.
(7) Facial muscle weakness: Due to the weakness of the expression muscles of the whole face, the patient often cannot close his eyes during sleep. Usually the expression is indifferent and the smile is unnatural, just like crying, also known as crying and laughing face. This face makes people look uncomfortable and the patient is in pain.
(8) Cervical muscle weakness: Severe cervical muscle weakness is more prominent, the patient has the phenomenon of drooping head when sitting, holding the chin with his hand to hold his head up, if the patient lies on his back (no pillow) he cannot flex his neck and lift his head.
6.What are the eye symptoms of myasthenia gravis?
(1) drooping eyelids: early on one side, late on both sides, and in many patients, when one eyelid stares up, the other eyelid droops down again, i.e., alternating left and right lid drooping phenomenon.
(2) Strabismus oculomotor disorders.
(3) diplopia.
(4) oculomotor disorders.
7.What are the characteristics of muscle weakness in patients with myasthenia gravis?
(1) The whole body skeletal muscle is easily fatigued or muscle weakness is fluctuating.
(2) Most of them show muscle weakness or even paralysis after continuous muscle contraction, which is reduced or relieved after rest.
(3) Light in the morning and heavy in the evening: the muscle strength is normal or the muscle weakness is reduced in the morning, and the muscle weakness is significantly increased in the afternoon or evening.
(4) The first symptom is often paralysis of one or both extraocular muscles, such as ptosis, strabismus and diplopia.
(5) The involvement of the muscles of the extremities is more severe proximally, manifested by difficulties in raising the arms, combing the hair, and walking up stairs; tendon reflexes are usually not involved and sensation is normal.
(6) The first treatment with anticholinesterase drugs can all relieve the symptoms of myasthenia gravis, which is a prominent feature of the disease.
8.What are the types of myasthenia gravis in adults?
According to the modified Osseman typing method, they can be classified as
I oculomotor type.
IIA mild generalized type, in which the limb muscle groups are often involved with the eye muscles, without the manifestations of pseudobulbar palsy, i.e., without difficulty in chewing and swallowing dysarthria.
IIB moderate generalized type, the involvement of extremity muscle groups is often accompanied by extraocular muscle paralysis, with manifestations of pseudobulbar palsy, and respiratory distress mostly occurs within six months.
III acute severe type with rapid onset, mostly progressing from weeks or months to respiratory distress.
IV late-onset severe type, mostly evolving from type I, IIA, and IIB in about 2 years.
V myasthenic type, rare.
9. Intense myasthenia gravis in children is divided into which categories?
(1) Neonatal congenital myasthenia gravis: Since most myasthenia gravis has a certain family tendency, the children mainly show ptosis, extraocular muscle paralysis, generalized muscle weakness after birth, and it is uncommon to have a weak cry and respiratory distress. Myasthenia gravis symptoms are mild but persistent. Blood levels of somatic antibodies are not high, and none of the plasma exchange treatments are effective.
(2) Childhood myasthenia gravis: The onset of this type is more common in children at 6 months of age, with peak incidence in the second and third years of life. The clinical features can be divided into oculomotor, brainstem and generalized types.
(3) Neonatal transient muscle weakness: Within a few hours to 3 days after birth, the child may show weakness in crying, difficulty in swallowing, sucking and breathing. The muscles are flaccid and the tendon reflexes are diminished or absent. The child rarely has extraocular muscle paralysis and ptosis. If family history is not noted, it can be easily confused with birth brain injury and myasthenia gravis syndrome.
10.What are the tests for myasthenia gravis?
(1) Drug test: Neostigmine test, Tensilon chloride test.
(2) Neuromuscular electrophysiological examination: commonly used induction continuous stimulation, damaged muscle response and rapid disappearance; electromyography suggests that the muscle contraction force is reduced, the amplitude becomes smaller. The amplitude of muscle action potential is reduced by more than 10%, and single fiber excitation conduction is delayed or blocked.
(3) Measurement of AchR antibody titer: anti-AchR-Ab in serum is increased in about 80% of patients; however, the increase of AchR antibody is not obvious in ocular muscle type cases, and the antibody titer is not proportional to the severity of clinical symptoms.
(4) Chest X-ray or thymus CT or MRI examination, mainly to understand whether thymus hyperplasia, hypertrophy or or tumor.
(5) Immunological examination: 70-93% of patients can be found positive for serum anti-acetylcholine receptor antibodies.
(6) Muscle biopsy: post-synaptic membrane folds at the neuromuscular junction are reduced and flattened, and the number of AchR is reduced.
11.What is myasthenia gravis crisis?
It refers to the critical phenomenon that patients with myasthenia gravis have a sudden and rapid deterioration in the course of the disease due to some reasons, with difficulty in breathing and life-threatening. Depending on the cause, myasthenia gravis (MG) crisis is usually divided into three types.
(1) Myasthenia gravis crisis: Most of them are due to the development of the disease itself. It can also be induced by infection, overexertion, mental stimulation, menstruation, childbirth, surgery, and trauma. The clinical manifestation is a sudden aggravation of myasthenia gravis, weakness in swallowing and coughing up sputum, difficulty in breathing, often accompanied by irritability and profuse sweating.
(2) Cholinergic crisis: It is seen in patients who have been taking large doses of bromipyridamole for a long time, or who have taken too much for a while. Before the occurrence of crisis, they often show nausea, vomiting, abdominal pain, diarrhea, excessive sweating, lacrimation, cold and wet skin, increased oral secretions, tremor of muscle bundles, and mental symptoms such as agitation and anxiety.
(3) Anti-arrest crisis: The dose of “bromipyridamole” remains unchanged, but the drug suddenly fails and severe respiratory distress occurs. It can also be caused by infection, electrolyte disturbance or other unknown reasons.
12.Which diseases should be distinguished from myasthenia gravis?
(1) Lambert-Eaton syndrome: Most of the disease starts after 50 years old, more common in men, and cholinesterase inhibitors are ineffective for treatment.
(2) Chronic inflammatory myopathy: compared with myasthenia gravis, there is no morning lightness and evening heaviness, negative repetitive electrical nerve stimulation, low serum AchR antibody titers, and ineffective anticholinesterase drug therapy.
(3) Oculomotor myotonic dystrophy: mainly distinguished from simple oculomotor myasthenia gravis, which is characterized by insidious onset, years or decades of disease, no fluctuation of symptoms, very slow progression, and ineffective anticholinesterase drug therapy.
(4) Progressive bulbar palsy: This disease is a type of motor neuron disease, similar to myasthenia gravis symptoms. The main difference is that the symptoms of this disease are inactive, with marked atrophy of the tongue muscles with fibrillation and electromyography suggesting typical neurogenic impairment. Anticholinesterase drug treatment is ineffective.
(5) Drug poisoning: neuromuscular transmission disorders caused by botulism, organophosphorus pesticide poisoning, snake bite, clinical symptoms will also improve with neostigmine or epsilon chloride, but these diseases have a clear history.
13. Is myasthenia gravis disease hereditary?
Myasthenia gravis is the most well-studied and representative autoimmune disease among human diseases in terms of its pathogenesis, which is the involvement of acetylcholine receptors on the postsynaptic membrane of the neuromuscular junction. The reason is that myasthenia gravis is an autoimmune disease, so myasthenia gravis has a certain genetic susceptibility, and some patients have a positive family history through the survey.
14. Can myasthenia gravis be completely cured?
No, but it can be treated. As long as you choose the right treatment method, you can completely control myasthenia gravis disease, so that the disease will not recur.
15. What are the consequences of not treating myasthenia gravis?
With the lightness or severity of the involved state of the organism, the health effects on the patients are various and different, specifically.
(1) Involvement of the medulla oblongata and swallowing muscles: slurred spitting, poor speech, nasal speech, inflexible tongue, resulting in difficulty in stirring food in the mouth. The volume of speech will become less and less with the time of speech, and in severe cases, only lip movement can be seen but no sound can be heard, and it is difficult to eat and easy to choke and cough when drinking water.
(2) Involvement of skeletal muscles throughout the body: The involvement of skeletal muscles throughout the body is also a risk of myasthenia gravis, with the extraocular muscles being the most common. Patients with myasthenia gravis may experience droopy eyelids and diplopia. When the muscles of the whole body are affected together, there is a typical disease of aggravation after fatigue and alleviation after rest, and the disease is light and heavy at night.
(3) Involvement of facial expression muscles and masticatory muscles: the manifestation of closed eyes is not tight, and the most common face is a bitter smile. Patients often have expressionless faces, as if with a mask, cannot puff their cheeks or blow, and do not have the strength to chew when eating, especially dry food is most obvious.
(4) Involvement of muscle groups of the limbs: involvement of the upper limbs will lead to the inability to lift both arms, combing hair, brushing teeth and dressing will become difficult; involvement of the lower limbs will lead to weakness of the legs when going upstairs, fatigue of the lower limbs when carrying things, difficulty in going up steps or getting into a car, etc. When riding a bicycle, there will be no strength for a long time, and there will also be hazards such as getting off, falling easily downstairs and difficulty in getting up from a squat.
16.How to control myasthenia gravis and prolong the survival period?
Although myasthenia gravis is difficult to treat, it does not mean that it is an incurable disease. One third of the patients can recover after treatment, but the key is early detection and early treatment.
(1) timely professional examination in order to avoid “misdiagnosis” delaying the disease.
(2) timely treatment of the disease, do not let the “disease” shorten life.
(3) Choose the correct treatment method, do not let the wrong treatment delay the best time for treatment.
17.What are the main hazards of ocular muscle type myasthenia gravis?
(1) Eye muscle involvement: specific manifestations are eyelid ptosis and diplopia, or the whole body muscles are involved at the same time, aggravated by fatigue, some recovery after rest, light and heavy, the scope and degree of the involved muscle groups vary greatly.
(2) Involvement of the medulla oblongata muscle: the phenomenon is slurred spitting, unfavorable speech, nasal speech, inability to extend the pendulum and movement, so that it is difficult to stir food in the mouth, the voice of speech gradually becomes smaller with the prolongation of speech time, in severe cases, only lip movement can not be heard, food swallowing difficulties, it takes a long time to eat a meal, choking and coughing easily when drinking water, etc.
(3) Complicated thymoma: Laboratory tests for myasthenia gravis show increased serum immunoglobulins in 2/3 of patients. In the majority of patients, serum antibodies to acetylcholine receptors are increased. Chest X-rays and thymus X-rays often show thymic hyperplasia or thymic tumors.
(4) Involvement of extremity muscles: when the upper extremity is involved, both arms cannot be raised, and it is difficult to comb hair and brush teeth and get dressed; when the lower extremity is involved, the first thing you notice is that your legs are weak when you go upstairs, and you feel fatigue when you lift your lower extremity. etc.
18.What are the treatment methods for myasthenia gravis?
(1) Drug treatment
Cholinesterase inhibitor: It is a symptomatic drug, treating the symptoms but not the root cause, and cannot be applied for a long time as a single drug. Commonly used are neostigmine methosulfate and bromipyridamole.
Adrenocorticosteroids: suppressing autoimmune reactions.
Immunosuppressants: for patients in whom adrenocorticosteroids are not effective or tolerated, or are not available.
(2) Plasma exchange: temporary relief of symptoms in patients with myasthenia gravis by removing antibodies to acetylcholine receptors from the patient’s blood, with an efficacy of no more than 2 months if not supplemented with other treatments.
(3) Intravenous immunoglobulin: Human immunoglobulin contains a variety of antibodies that can neutralize autoantibodies and regulate immune function. Its effect is comparable to that of plasma exchange.
(4) Thymus treatment
Surgical thymectomy: It can remove the initiating antigen of autoimmune reaction. After surgery, about 70% of patients’ symptoms can be relieved.
Thymic radiation therapy: mainly used to treat those who are not suitable for thymectomy.
19.What is the relationship between thymoma and myasthenia gravis?
The relationship between thymoma and myasthenia gravis is very close.
(1) 75%-80% of myasthenia gravis patients have thymus abnormalities, 60% of which are thymic hyperplasia, and about 12% of myasthenia gravis patients have thymoma.
(2) Thirty percent of patients with thymoma have myasthenia gravis, and about 10% (mainly elderly men) have thymoma that may cause paralysis due to invasion of their adjacent vital structures.
(3) Thymocytes in patients with thymoma do not usually express acetylcholine receptors, but elevated serum titers of acetylcholine receptor antibodies and the presence of antibodies to several intracellular muscle proteins produce myasthenia gravis.
(4) Generally, most of the symptoms can be improved or relieved after thymectomy, which is related to the reduction of thymosin secretion by removing thymic tissue.
20.What are the indications for thymectomy surgery?
More than 90% of patients with myasthenia gravis have thymus abnormalities, and thymectomy is one of the effective treatments for myasthenia gravis.
(1) It is suitable for patients with myasthenia gravis of generalized type with no contraindication to surgery who develop between 16 and 60 years of age, and most of them can get significant improvement after thymectomy.
(2) Patients with myasthenia gravis combined with thymoma account for 10% to 15% of patients, which is an absolute indication for thymectomy.
21.Why is myasthenia gravis likely to occur even after thymectomy?
(1) The surgery acts as a causative factor to make the original underlying myasthenia gravis manifest.
(2) The diagnosis of myasthenia gravis was missed because the original myasthenia gravis was not obvious, and thymus removal was performed because thymoma was found, but because thymus removal was not complete, or there was ectopic thymus, the diagnosis of myasthenia gravis was made only when the disease was heavy to a certain extent, so it gave a wrong impression that myasthenia gravis occurred only after thymus removal, but in fact it did not.
(3) Removal of inhibition: The presence of the original thymoma may put the body itself in a state of immune suppression, and when the thymoma is removed will cause the abnormal immune manifestation of this suppressed state, and the symptoms and signs of myasthenia gravis will appear clinically.
(4) Other factors, i.e., the possibility that extra-thymic factors play a role in the pathogenesis of myasthenia gravis.
22.How to treat myasthenia gravis oculomotor type?
Myasthenia gravis can develop at any age, and 10-20% of them can be cured by themselves, but most of them can develop into generalized myasthenia gravis within two years.
(1) If myasthenia gravis is accompanied by thymoma or thymic hyperplasia, it can be treated by surgery, but if not, there is no need for surgery because myasthenia gravis has mild symptoms that can be treated by medication, and surgery has certain risks.
(2) We can treat myasthenia gravis with anticholinesterase drugs and corticosteroids. These drugs can improve the symptoms, and about 50% of the patients have better treatment effect, and the common side effects of these drugs are diarrhea and digestive tract cramps.
23.What is the prognosis of myasthenia gravis?
The prognosis of myasthenia gravis patients is generally good, a small number of patients can be completely relieved after treatment, most patients can be maintained with drugs to improve symptoms, and the majority of patients with good results can carry out normal study, work and life. However, the mortality rate of myasthenia gravis crisis is high.
24. Can myasthenia gravis recur?
(Myasthenia gravis is an autoimmune disease, and one of the characteristics of this disease is that the course of the disease is chronic and prolonged, alternating between remission and deterioration, and most patients can be controlled after treatment, that is, the clinical symptoms and signs of patients disappear, and they can live, study and work normally as normal people, and stop all drugs for myasthenia gravis). However, it is necessary to understand the triggers of recurrent symptoms in order to take appropriate preventive measures and active treatment, so as to avoid or reduce the recurrence of myasthenia gravis symptoms. Such as cold, mental trauma, various infections in the body, overwork, endocrine disorders, immune dysfunction, women’s menstrual period and so on many factors and relapse or aggravate the disease, therefore, myasthenia gravis symptoms have recurrent nature.
25.How to prevent the recurrence of myasthenia gravis?
(1) Avoid triggering factors
Common triggers include infection, surgery, mental trauma, systemic diseases, excessive fatigue, female physiological period, pregnancy, childbirth, smoking, alcohol consumption, thymoma recurrence, etc.
(2) Use drugs with caution
Antibiotics: gentamicin, streptomycin, kanamycin, tetracycline, oxytetracycline, bacillus phthalein, polymyxin, tobramycin, quinolones, macrolides are used with caution.
Use with caution for lipid-lowering drugs.
Finasteride, Valium, Advil, morphine, ether, anesthetic muscle relaxants, procaine, aminoglycosides.
Quinine, quinidine, procaine amide, dormantine, fenadine.
Arrow poison, succinylcholine.
Thymidine, kazensu, Byungnincktong, immune enhancers.
Toadstool and proprietary Chinese medicines, such as: Liu Shen Wan, Throat Disorder Spirit, etc., pearl layer powder.
Do not casually give children with myasthenia gravis a variety of oral solutions sold on the market that claim to contain immune enhancing effects.
26. What are the dietary considerations for myasthenia gravis?
Patients with myasthenia gravis should pay attention to diet, not too hungry or too full, in a regular and moderate manner, while a variety of nutrition should be properly deployed, not partial diet, to maintain a regular life.
27.What should be noted in the life of patients with myasthenia gravis?
(1) Regular living, arrange a good day, sleep on time, wake up on time, do not stay up late, and combine work and rest.
(2) Prevention of colds, myasthenia gravis patients have poor resistance, colds will not only contribute to the relapse or aggravation of the disease, but also further reduce the body’s resistance to disease.
(3) Diet should be moderate, not too hungry or too full, but regular, moderate, while a variety of nutrition should be properly deployed, not partial food.
(4) Pay attention to the appropriate amount of exercise, exercise to enhance physical fitness, but not too much exercise, especially in patients with myasthenia gravis, excessive exercise will aggravate the symptoms, so patients should choose some exercises to help restore health according to their own situation. Patients who are more seriously ill or bedridden for a long period of time should be given appropriate massage to prevent the production of bedsores.
(5) Patients should have a good attitude and confidence in recovery in treatment. Encourage patients to have positive and optimistic treatment confidence, reduce the patient’s psychological burden, and avoid mental stimulation and excessive mental (physical) exertion.
(6) Pay attention to various infections, maintain a regular life, diet should be rich in high-protein foods such as: chicken, duck, fish, lean meat, tofu, soybeans, eggs, vegetable protein and animal protein, as well as fresh vegetables and fruits, nutrition is very important to patients, pay attention to the digestibility of food.
(7) Avoid eating raw, cold and spicy food, and avoid the stimulation of tobacco and alcohol.
28.What are the emergency treatment measures for myasthenia gravis families?
(1) Avoid overexertion, cold, infection, trauma and anger in mild cases, and do not stay under the hot sun for too long to prevent myasthenia gravis from occurring.
(2) In case of myasthenia gravis attack, you should rest in bed, keep sedated and quiet, keep the room air clear, remove nasal and oral secretions in time, and keep the airway clear.
(3) Myasthenia gravis crisis.
In case of crisis attack, take to hospital for resuscitation as soon as possible.
If you can identify the specific kind of crisis, you can do the following.
In myasthenia gravis crisis, inject neosporin 1mg intramuscularly immediately, repeat if necessary, and switch to oral administration after symptoms improve.
In cholinergic crisis, discontinue all anticholinesterase drugs and administer intramuscular or intravenous atropine 0.5-2 mg, repeated once daily over 15-30 minutes.
In reflexive crisis, discontinue anticholinesterase drugs to allow recovery of acetylcholine receptor function in the motor end plate, and then start anticholinesterase drugs in small doses after at least 72 hours.
If the nature of the momentary crisis is unknown, anticholinesterase drugs may be suspended and oral prednisone may be tried.
Prohibit the use of drugs that can affect the transmission function of the nerve-muscle junction, such as anesthetics, sedatives and analgesics, muscle relaxants, antiarrhythmics and certain antibiotics.
No matter what kind of crisis, attention should be paid to ensure respiratory ventilation, and if the condition does not improve in early treatment, artificial respiration should be performed immediately.
29.What are the side effects of hormone therapy for children with myasthenia gravis?
(1) Peptic ulcer: In order to prevent the occurrence of gastric ulcer, antacid drugs such as aluminum thioglycollate can be taken before each dose of hormone. Observe the color of the stool and report any black stool to the doctor. Those who have a history of gastric ulcers or gastrointestinal bleeding in the past should preferably switch to other therapies and avoid hormones.
(2) Diabetes mellitus: Because hormones have the effect of raising blood sugar, they can cause diabetes mellitus. Before starting treatment, blood sugar should be checked, and after starting treatment, it should be reviewed regularly.
(3) Osteoporosis: Calcium and vitamin D can be taken appropriately.
(4) Femoral head necrosis: adults should be highly alert to the possibility of femoral head necrosis when applying hormones in high doses. The hormone dose should be reduced in time after the symptoms of muscle weakness improve. If necrosis occurs, hormones should be discontinued and activities should be reduced.
(5) Cataracts: Patients taking hormones for a long time should have regular eye examinations, and if cataracts occur, the hormone dose should be reduced.
(6) Adrenal insufficiency: The general method of taking hormones three times a day can easily cause adrenal insufficiency, so now special emphasis is put on hormones should be taken once a day, after breakfast.
(7) Infection. Patients are prone to infections because hormones can reduce the immunity of the patient’s body. The long-term use of large amounts of corticosteroids can reduce the body’s ability to resist disease, increase the chance of bacterial and fungal infections, and cause the activity and spread of the original tuberculosis lesions.
Thus, although hormone therapy for myasthenia gravis has certain effects, hormone is a double-edged sword, which can both treat people with the disease and may lead patients to the abyss. Therefore, when using hormones to treat the disease, you must grasp the right degree, which requires the guidance of professional medical personnel throughout.
30.Is it possible to have children with myasthenia gravis?
Myasthenia gravis is a heritable disease, but it is not contagious in nature. The symptoms of myasthenia gravis during pregnancy are not the same for different people, some people have no significant changes, while some people may have aggravated or reduced symptoms; while delivery and postpartum often aggravate the symptoms of patients, and myasthenia gravis crisis may occur in serious cases. Therefore, it is currently recommended that childbirth is not recommended until the disease has fully recovered. Contraception is preferred for female patients of childbearing age with myasthenia gravis. If the symptoms do not fluctuate or improve, pregnancy can be considered, but strict prevention of postpartum myasthenia crisis is required.
31.How to treat myasthenia gravis patients with cold?
(1) Treatment of fever in case of cold: paracetamol, rehydration or intramuscular injection of Chaihu, physical cooling (alcohol bath or ice pack) in case of high fever.
(2) Treatment of severe colds: go to the local hospital for treatment, but tell the doctor that you have myasthenia gravis to avoid misuse of drugs that aggravate myasthenia gravis. If the symptoms of myasthenia gravis are significantly worse after a cold, the dosage of bromipyridamole can be increased appropriately. Since pneumonia is an important factor leading to myasthenia gravis crisis, once there are signs of pneumonia (high fever, cough, sputum, etc.), go to the hospital for timely treatment and be highly alert to the occurrence of myasthenia gravis crisis. Of course it is best to prevent colds in advance: keep indoor air circulation, wash hands regularly and avoid going to crowded places.
32.How to treat myasthenia gravis aggravated by menstruation in women?
The specific cause of myasthenia gravis exacerbation during menstruation is not clear, but it may be related to the change of hormone level during menstruation that leads to immune dysfunction, which indirectly involves the acetylcholine receptors on the postsynaptic membrane at the neuromuscular junction, leading to the exacerbation of myasthenia gravis during menstruation or the occurrence of critical signs. If a woman develops myasthenia gravis during menstruation, she needs to actively cooperate with her doctor for treatment. The most important thing to note in the patient’s life is to keep her mood relaxed, and she can regulate her mood by various methods, such as listening to music, talking and chatting, watching entertaining programs, etc., to divert her attention and stabilize her emotions, while paying attention to keeping warm.