MYASTHENIA GRAVIS

 MYASTHENIA GRAVIS

Myasthenia grace is a rare disease, with a prevalence of 5 per 100000. It is a disorder of neuromuscular transmission. Females are more prone with this disorder than males.
 This is characterised by 
> weakness and fatigue in some or all muscle groups
>  weakness worsening on repeated exertion or towards the end of the day, and relived by rest 
This condition is a consequence of an auto immune destruction. 
It occurs when communication between nerve cells and muscles impaired. The most commonly affected muscles of eyes , face, swallowing and also muscles responsible for breathing and even arms and legs. 

Symptoms: 
1. Weakness of eye opening and eye closing
2. Weakness of neck muscles and results in lolling of the head 
3. Fatigue by movement against any resistance 
4. Muscles wasting 
5. Difficulty in swallowing 
6. Difficulty in speech 
7. Weakness of jaw muscles allows the mouth to hang open 
8. Double vision 
9. Change in face expression 
10. Shortness of breath 
11. Weakness in arm and leg muscles 
12. Problems with chewing

 Causes : 
> In Thymus gland dysfunction 
> Genetic factors also may be associated with this disorder 
> When communication between nerve cells and muscles impaired 
> A reduction of Acetylcholine receptor sites in post synaptic folds. Reduced receptor synthesis and increased receptor destruction, and also the blocking of receptor response to acetylcholine, all are responsible for the disorder. 


TREATMENT: 
1. Anticholinesterase drugs : inhibit cholinesterase , the enzyme responsible for the break down of acetylcholine allowing enhanced receptor stimulation. So that more acetylcholine is available to effect neuromuscular transmission. 
2. Steroids 
3. Immunosuppressants for patients who do not respond to steroids 
4. Plasmapheresis 
5. Speech therapy 
6. Occupational therapy 
7. Physiotherapy : Low impact exercises like swimming, slow jogging, slow walking may actually reduce fatigue. Because inactivity may increase obesity and chances of coronary heart disease, osteoporosis. 
8. Surgery : when Thymoma is present
9. Blood transfusion to replace deficiencies in the blood stream 
10. Muscle strengther for better muscle function

Note: Please consult your doctor before starting any exercise program

Motor Neuron Disease

 MOTOR NEURON DISEASE or AMYOTROPHIC LATERAL SCLEROSIS 

It is a disease in the nervous system that weakens the muscles. It is a progressive condition characterized by degeneration of upper and lower motor neurons or nerves in the brain and the spinal cord . There may be occasional involvement of other areas of the central nervous system. The autonomic nervous system, sensory nerves, lower sacral segments of the spinal cord and the three cranial nerves that control movement of the eyes are unaffected. 
Commonly seen in males than females. 
The mean age of onset is 55 years. 

Causes: 

• Genetic susceptibility 
• Chronic virus infections like polio virus 
• Exposure to environmental Toxins and chemicals 

Signs & symptoms: 

1. Weakness and wasting of extremities 
2. Difficulty in speech
3. Difficulty in swallowing 
4. Dementia 
5. Expression less face 
6. Tongue is immobile 
7. Muscle cramps 
8. Shortness of breath 
9. Tight and Stiff muscles 
10. Muscle cramps

Treatment: 
There is no cure for motor neuron disease but Symptomatic treatment and supporting both patient and family as these progress and their needs changed. 

1. Nutrition counselling 
2. Physiotherapy 
3. Walking aids
4. Splints 
5. For respiratory failure conditions, ventilator assistance 
6. Speech therapy if there is any difficulty in speech by speech therapist

Physiotherapy Treatment:
Proper assessment should be taken and will plan treatment accordingly. 

1. Range of motion exercises  to maintain movements in the joints. 
2. Active exercises when the person is able to do exercises without any help. 
3. Active assisted exercises when they cannot fully do exercises on their own, and a helper assists the movements. 
4. Passive movements: If movements become more difficult due to weakness or spasticity then passive movements are indicated to prevent secondary impairments of the musculoskeletal system. 
5. Breathing exercises for breathing difficulties and to maintain lung capacity. 
6. Massage techniques to increase blood circulation and aids relaxation in the muscles and reduces stiffness. 
7. Physiotherapist Will give advice on the type of wheelchair required according to the person requirement.
8. Terminal stage of the disease: The person may be cared at home or admitted in the hospital. Managing of symptoms and ensuring the person more comfortable are the main aims at this stage.

Note:Please consult your doctor and plan exercises accordingly