Neurology Lecture: An Insight into Myasthenia Gravis

Myasthenia gravis (MG) is a neuromuscular condition involving the skeletal muscles; wherein there is decreased acetylcholine. This decrease is due to the inappropriate creation of antibodies that go against acetylcholine receptors.

Muscles fail to contract because of the absence of the neurotransmitters that are responsible for contraction, leading to the manifestations of drooping eyelids, paralysis of the face, and difficulty breathing.

Medications

If the body is attacking itself, how do we tell it to stop? The obvious answer is through medications. What are the different medicines given to clients who are suffering from myasthenia gravis?

1. Intravenous Immunoglobulin (IVIG)

Intravenous immunoglobulin is the kind of drug that is given to clients with myasthenia gravis, similar to what is given to multiple sclerosis clients, that helps in decreasing the body’s immune response. IVIG serves as bait for the antibodies; that, instead of attacking the neurotransmitter or acetylcholine receptors, the antibodies turn on the IVIG.

Intravenous immunoglobulin is one of the bait-and-switch things that the medical field does for clients.

2. Steroids (Prednisone)

Steroids like prednisone are anti-inflammatory drugs that are also given to clients suffering from COPD and Cushing’s disease because, aside from decreasing inflammation, prednisone also weakens the immune response.

3. Cholinergic

A notable effect of cholinergic drugs to MG clients is that it’s going to increase the amount of saliva production; thus, helping the client’s ability to swallow. Because the body targets acetylcholine, saliva production will reduce, and reduced saliva would result to difficult muscle movement, specifically around the mouth and esophagus.

Thymectomy: Surgery for MG

If medication is not enough, another route that doctors would consider is doing a surgery called thymectomy. Now, some doctors believe that the thymus causes an over-immune response that attacks the acetylcholine receptors; on the other hand, there are those who don’t agree.

Nursing Considerations

When taking care of a client suffering from myasthenia gravis, there are a couple of nursing considerations that you have to keep in mind, primarily:

1. The positive cholinergic, pyridostigmine, should be given before meals to ensure that swallowing is adequately facilitated.
2. Prednisone is going to cause a decreased immune response; therefore, nurses have to watch out for clients developing an infection because, much like those who are undergoing chemotherapy, MG clients taking prednisone will not show signs and symptoms of infection.
3. The client is going to have an increased risk for aspiration or will experience swallowing difficulties while on medication. Thick liquids must be given instead of just water or thin liquids.

Client Teaching

Very important teaching that you have to emphasize to myasthenia gravis clients who are taking prednisone and IVIG is that they have to immediately contact their physician if they show even the slightest increase in temperature.

Even if the temperature is just slightly above 100 Fahrenheit, let’s say 100.5 Fahrenheit, you have to contact the doctor at once. This is because clients who are taking prednisone and IVIG are immune-compromised and the little increase in temperature will have severe effects on the client.