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Neurology (Expert Forum)
A Few Questions About Myasthenia Gravis
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A Few Questions About Myasthenia Gravis
by manytingles, Apr 23, 2004 12:00AM
Hi Doctors,
I am a 26 yo M who has had ptosis for at least 6 years and recently (6 months ago) developed mild, fluctuating double vision in my left eye. It looks more like there are "ghost" images than true double images. I went to the neuro-opthomologict at a major acamedic institution, and he noted that it was unlikely to be MG but ordered a blood test to confirm. My tests were normal except my Ach-binding antibodies were .03, which is high according to the lab. Is this specific enough for MG or should I re-test? According to my CT w/ contrast, I have no thyoma but some residual thymic tissue in my anterior mediastinium. Is this normal or is my thymus enlarged? Also, for the past 6 years I have had periods that last for days where I feel like I can't draw a deep enough breath. I don't breath faster, just have a feeling like I am not hetting enough oxygen. This has perviousely been attributed to anxiety by physician and cardiolgist.
I've had all of the symptoms for about 6 years except for the diplopia. Given that, I have read that symptoms usually reach maximum severity within 3 years of onset. Is the ptosis (6 yr.) considered onset or is the diplopia (6 mo.)
Also, given that my symptoms are not currently disabling, would you suggest I start medication? Would you suggest a thyoectomy in a case like this? I feel pretty much good -- sometimes the diplopia is bothersome and the breathing thing gives me anxiety.
Also, in general, howe serious is this disease?
Thank you for your service to the community.
I am a 26 yo M who has had ptosis for at least 6 years and recently (6 months ago) developed mild, fluctuating double vision in my left eye. It looks more like there are "ghost" images than true double images. I went to the neuro-opthomologict at a major acamedic institution, and he noted that it was unlikely to be MG but ordered a blood test to confirm. My tests were normal except my Ach-binding antibodies were .03, which is high according to the lab. Is this specific enough for MG or should I re-test? According to my CT w/ contrast, I have no thyoma but some residual thymic tissue in my anterior mediastinium. Is this normal or is my thymus enlarged? Also, for the past 6 years I have had periods that last for days where I feel like I can't draw a deep enough breath. I don't breath faster, just have a feeling like I am not hetting enough oxygen. This has perviousely been attributed to anxiety by physician and cardiolgist.
I've had all of the symptoms for about 6 years except for the diplopia. Given that, I have read that symptoms usually reach maximum severity within 3 years of onset. Is the ptosis (6 yr.) considered onset or is the diplopia (6 mo.)
Also, given that my symptoms are not currently disabling, would you suggest I start medication? Would you suggest a thyoectomy in a case like this? I feel pretty much good -- sometimes the diplopia is bothersome and the breathing thing gives me anxiety.
Also, in general, howe serious is this disease?
Thank you for your service to the community.
Doctor's Answer
by CCF-Neuro-M.D.-CS, Apr 28, 2004 12:00AM
Methods for confirming the disgnosis include repeating the anti-bodies at another lab, and including the binding, blocking, and modulating anti-bodies. You could also have a tensilon test, which involves the injection of a short acting drug which temporarily reverses the affects of MG. The last test is a repetitive nerve conduction test or a single fiber EMG.
The ptosis may not be related to the MG. Also, it is not clear that your breathing complaints are related to the MG. If you have not had formal pulmonary function studies, it would be reasonable.
Your symptoms currently appear to be occular. The longer your symptoms remain occur the better the prospect of not developing generalized MG. Regarding treatment, symptomatic treatment can be initiated with mestinon. Then you need to consider low dose prednisone therapy as a long term solution for controlling the disease. Thymectomy for only occular MG is controversial. If the diagnosis is confirmed to be MG, it would be reasonable to ask a MG specialist about the need for thymectomy. Sorry for the delay. I hope this helps.
The ptosis may not be related to the MG. Also, it is not clear that your breathing complaints are related to the MG. If you have not had formal pulmonary function studies, it would be reasonable.
Your symptoms currently appear to be occular. The longer your symptoms remain occur the better the prospect of not developing generalized MG. Regarding treatment, symptomatic treatment can be initiated with mestinon. Then you need to consider low dose prednisone therapy as a long term solution for controlling the disease. Thymectomy for only occular MG is controversial. If the diagnosis is confirmed to be MG, it would be reasonable to ask a MG specialist about the need for thymectomy. Sorry for the delay. I hope this helps.
