Does myasthenia gravis require hospitalization?

Written by Zhang Hui
Neurology
Updated on December 23, 2024
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Myasthenia Gravis is a type of neuroimmune disease within the field of neurology which fundamentally stems from issues with the patient's own immune function. Whether hospitalization is necessary depends critically on the severity of the disease. If Myasthenia Gravis manifests only as ocular symptoms, such as ptosis and double vision, hospitalization is generally not necessary. It is important to take certain medications, primarily cholinesterase inhibitors and corticosteroids, but regular outpatient follow-ups are essential. However, if Myasthenia Gravis is generalized, with noticeable whole-body weakness, particularly if accompanied by swallowing difficulties and coughing while drinking, hospitalization is required. If a myasthenic crisis occurs, presenting with respiratory muscle weakness and breathing difficulties, hospitalization is certainly needed, and admission to the ICU might be necessary.

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Neurology
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Myasthenia Gravis Clinical Manifestations

The clinical manifestations of myasthenia gravis include fluctuating weakness of specific striated muscles that is fatigue-prone. Symptoms are generally milder in the morning and worsen by night, increasing after sustained activity and alleviating after rest. Additionally, some patients may experience ocular muscle weakness, presenting with ptosis and diplopia, which could be among the earliest symptoms. Eye movement disorders may occur, preventing the eyes from looking to one side, and pupil abnormalities may be present. Facial muscle weakness can lead to cheek puffing and air leakage, inability to close the eyes, or asymmetry of the mouth, resembling a forced smile. There may also be weakness in the masticatory muscles, leading to difficulties in chewing and swallowing, potential speech impairments, and coughing when drinking water. Neck muscle weakness may manifest as difficulty in lifting the head. Muscle weakness can affect various limbs, primarily proximally, and respiratory muscle weakness can lead to breathing difficulties and dryness.

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What department is myasthenia gravis under?

Myasthenia gravis, this disease definitely requires registration with the Department of Neurology as it is a relatively common disease in neurology, and doctors in other departments are not particularly familiar with this disease, let alone diagnosis and treatment. Myasthenia gravis is an immune disease of the nervous system, and patients may experience generalized fatigue, which can be alleviated after rest. It is characterized by clinical symptoms that are lighter in the morning and more severe in the evening. Additionally, symptoms such as ptosis, double vision, and even some difficulties in swallowing and unclear speech, known as bulbar paralysis, may occur. This disease requires a thorough chest CT scan, as many patients have an associated thymoma. Furthermore, an electromyography examination is needed to check for antibodies related to myasthenia gravis, which is also important for guiding further treatment.

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What is a good medicine to take for myasthenia gravis?

Myasthenia gravis is an autoimmune disease of the nervous system. Patients need to take medication for a long time, otherwise, antibodies to acetylcholine receptors might continue to be produced, further worsening the clinical manifestations. The medications taken by patients with myasthenia gravis mainly include the following types, the first being cholinesterase inhibitors. These drugs can inhibit the breakdown of acetylcholine by cholinesterase, thereby improving the transmission function between nerve and muscle junctions, and improving the clinical symptoms of patients. It is best to take these medications before meals for better absorption. The second type of medication mainly includes corticosteroids. They can suppress the body's immune response and reduce the production of antibodies, which is very helpful for the recovery from the disease. Long-term usage and gradual dosage reduction are necessary. Additionally, some immunosuppressants need to be taken. Taking these immunosuppressants also aims to suppress the immune response. However, it is essential to be aware of their adverse effects, such as suppression of bone marrow function, and damage to liver and kidney functions.

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myasthenia gravis-related antibodies

Most cases of myasthenia gravis are mediated by acetylcholine receptor antibodies, involving cell-mediated immunity with complement, generally affecting the neuromuscular junction and causing a neuromuscular transmission disorder. This results in an acquired autoimmune disease of muscle weakness. However, a small number of patients with myasthenia gravis are mediated by muscle-specific kinase antibodies or low-density lipoprotein receptor-related protein 4 antibodies. Its main clinical manifestations include skeletal muscle weakness, fatigue, worsening with activity, and significant alleviation or reduction of symptoms after rest and the use of acetylcholinesterase inhibitors. Additionally, the disease can occur at any age, with females being more affected than males before the age of 40. Between 40 and 50 years old, the incidence rates between males and females are comparable, but after 50 years of age, the incidence rate in males is higher than in females.

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What should I do if myasthenia gravis is accompanied by a fever?

Patients with myasthenia gravis are most afraid of developing a fever, as a fever may indicate an infection, especially a bacterial infection. If a bacterial infection occurs, it can easily trigger a myasthenic crisis. The patient may experience weakness in breathing and even respiratory failure, which can be life-threatening. Therefore, it is essential to address the situation promptly. The recommended approach when a fever occurs is as follows: First, quickly determine the cause of the fever, complete routine blood tests, calcitonin, and other relevant assays to confirm if it is caused by a bacterial infection. Second, symptomatically manage the fever, possibly using antipyretic medications. Third, if it is a bacterial infection, it is crucial to promptly administer a significant amount of effective antibiotics to treat it. Controlling the bacterial infection can prevent the progression of myasthenia gravis to a more severe state. (Note: Medication should be used under the guidance of a doctor.)