6 months ago experienced double vision for about a month. All tests were negative except for a borderline positive SF EMG test and CT chest which showed 3cm x 3cm thymus. Was put on mestinon x 3 times a day. Double vision cleared up for a number of months and now have a relapse. My right eye is barely moving, and always looking upwards. Redid the SF EMG and and this time it was negative. What should be the next step? Have been covering one eye for several weeks to get through the day. My doctor does not want to put me on prednisone as there is no clear diagnosis.
Myasthenia gravis is an autoimmune condition where in antibodies are secreted against one's own body cells.Most of the time thymus gland tumour(thymoma) has been associated with myasthenia.
You would notice gradually weakening over due course of time.
Do follow your neurologist's opinion
The most characteristic feature of myasthenia gravis is muscle weakness that increases on activity and improves after rest.Weakness of eye muscle is usually the first symptom.Diagnosis can be made by physical examination, blood test to identify antibodies against acetylcholine receptors, neurophysiological test like measuring fatiguability after repeated stimulation of a muscle, and rarely an edrophonium test is performed, the test requires IV administeration of edrophonium chloride temporarily relieves muscle weakness in patients with myasthenia. You can discuss all these with your treating doctor.Treatment is usually neurostigmine and pyridostigmine to overcome muscle weakness, prednisone for immunosupression and thymectomy in rare cases.
How are you feeling now?
Myasthenia gravis can occur in all age groups, but it is common in women in their twenties and thirties and men in their fifties and sixties. The most important features are weakness and fatigability of muscles. The weakness increases during repeated use and may improve following sleep or rest.
The cranial muscles, particularly the lids and the extra ocular muscles, are often involved early, and diplopia and ptosis are common initial complaints.
The drug Edrophonium is used first in the dose of 2mg and later in dose of 8mg. Before starting the test, objective end-point has to be selected. Examiner should concentrate on one or more unequivocally weak muscle groups and evaluate their strength objectively.
An initial dose of 2mg of Edrophonium is given intravenously. If definite improvement occurs, the test is considered positive. If there is no change, then 8mg is repeated.
They have done repeat EMG test, did they stop mestinon before doing the test? If yes, how long before it was stopped? If no then EMG test report could be affected.
Hope this helps.
Stopped mestinon 24 hours before SF EMG test. I had a tensilon test during the first episode without any improvement. my neurologist now says that he will put me on prednisone. i have heard so many bad things about it that I am confused about what to do.
My weakness does not fluctuate over the course of the day. It is gradually getting worse without the slightest short-lived improvement. first week diplopia came back but only on upper gaze, second week the entire view was affected, and now my right eye is barely moving.
How are you?
I think you should try to undergo immunosuppressive therapy. Immunosuppressive therapy could be done with the help of Glucocorticoids, azathioprine etc.
Glucocorticoids, when used properly, produce improvement in myasthenia weakness in great majority of patients. The initial dose should be relatively low to avoid early weakening that occurs in 1/3rd of patient. The dose is increased stepwise.
Hope this helps.
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