Re: nocturnal myoclonus & MG

Posted By Tess on November 15, 1997 at 01:27:36:

In Reply to: nocturnal myoclonus & MG posted by Karen on November 11, 1997 at 08:03:19:







: I have had nocturnal myoclonus for about 2/92. I am currently on Klonipin (klonopin) and Baclofen with good control.  I also have MG (diagnoised in 95, but probably there in 2/92) which is also in good control.  
My main concern is bladder urgency and incontinence since 1993.  Testing
has shown that I have abd unstable bladder - no other problems assoc with the bladder.  I have been on Levbid at night with good control until the past year.  Every day the urgency and incontinence gets worse. I have tried many different anticholinergics during the day, but my eye droop becomes severe.  Kegals are not working either.I have also been told that the incontence may be a side effect of the Bacolfen and/or Klonipin (klonopin) - and that alternative drugs for the myoclonus woud not be any better.
Is the bladder problem related to the MG?  Any other suggestions to control the incontinence? (I am a 45 year old professional and find incontnence unacceptable at this point in my life.)  Any assistance would be greatly appreciated

Please check the following article, written by James Howard, affiliated with the National Myasthenia Gravis Foundation (MGFA):
Urinary Incontinence in Myasthenia Gravis:
A Single-Fiber Electromyographic Study
James F. Howard,Jr. M. Kathleen Donovan, and M. Susan Tucker, Chapel Hill, NC

Urinary symptoms of urgency and incontinence have been reported only rarely in patients with myasthenia gravis (MG) and then most often in association with myasthenic crisis.
We report the case of a 31-year-old women who in December 1987 had the onset of chest pain and was found to have a lymphocytic thymoma. In June 1989 she developed urinary incontinence, was found to have an open bladder neck, and underwent a suspension procedure for stress incontinence in January 1990. Eight months later she developed exertional fatigue and a diagnosis of MG was made. In July 1991 there was a recurrence of urinary incontinence. These symptoms clustered toward the end of the day and at trough Mestinon dose. Nero-urophysiological studies demonstrated her previous open bladder neck, the inability to sustain a pelvic floor contraction, and increased bladder wall contraction. Single-fiber electromyography  (SFEMG) recordings from the anal sphincter demonstrated a mean consecutive difference (MCD) of 88 uSec, and 11% of fiber pairs had impulse blocking while recordings in the extensor digitorium communnis muscle were normal. Following a course of plasma exchange, there was significant clinical improvement with a reduction in the frequency of urinary incontinence, and im provement in anal sphincter SFEMG studies (MCD, 60 uSec with no blocking). This case demonstrates that in those myasthenic patients with predisposing bladder outlet dysfunction, urinary incontinence may be a manifestation of worsening MG.




My MG is not a sportscar!