MG vs Spinal Stenosis

  I wrote several weeks ago about  my husband and the MG he was diagnosed with about 3 years ago.  You promptly replied for which we were appreciative.  For some reason I couldn't figure out how to reply.  Anyway, I will try again. Very briefly,  following his diagnosis he had a thymectomy, plasmapheresis, IVIG and high dose steroids.  In general he has been much improved the past couple of years but continues to take Prednisone 15mg one day and 9 the next.  He rarely uses Mestinon--in general it does not help with his fatigue.    A couple of years ago, he was also diagnosed with spinal stenosis of L5-S1.  He has had several rounds of LEBs, the latest, this summer--that provided him with moderate relief from the back and leg pain.  He has significant numbness in his left foot which he has had from many years of having ruptured discs.  Since he has been on steroids, he has also developed diabetes controlled by diet and Glucophage. Since mid-August, he has had an increase in weakness and general fatigue and especially difficulty in walking.  He just feels rotten a lot of the time--very tired and no energy.  He continues to work full time as a high school teacher and has some church/civic activities that he is able to continue with.  We wondered if you might be able to offer some suggestions about whether he should see the neurologist or orthopedist.  His last neurologist visit was just after his symptoms began and he was just advised to continue to taper the prednisone.  Any thoughts you might have would be appreciated.  Thanks, Suzanne
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Thanks for your question.  It is difficult to determine from the described
symptoms whether your husband's lower extremities symptoms are caused by
the MG, or by the spinal canal problem.  Given the generalized fatigue, it
is more likely that MG is the cause, however it is important to re-evaluate
his lower back problems.  Aside from a careful physical/neurological examination,
his physician might consider an electrophysiological test, such as an EMG/NCS.
Another approach would be to try a pharmacological "challenge" with a very
short-acting anti-cholinesterase medication (despite his lack of success
with Mestinon).  Regarding your last question, given the progressive worsening
of his symptoms, your husband should definitely be seen by his neurologist.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.