Suggest treatment for myasthenia gravis and muscle weakness

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Posted on Sat, 28 Feb 2015 in Brain and Spine
Question: I have been diagnosed with Myasthenia Gravis by two Neurologist. The third says I do not have MG or any other neuromuscular disease. The positive diagnosis was given due to my symptoms, that I responded to Mestinon (sustained release and q 3hours), Prednisone (now at 50mg qd) and Imuran (now at 200mg qd). I have had 5 IVIG treatments (10 weeks ago) with good response at that time. However, I am antibody negative. My RNS, SFEMG, and MRIs are also negative. For that reason and her opinion that I do not have muscle weakness, fatigue can be caused by anything, tremors are not associated with MG, I'm on treatment and still get symptoms that there is no way I have MG or any other neuromuscular problem. I am a lot better but not back to base line. I am having most of my problems with walking, drooping eyelids (worse on left), weak arms and fingers, speech, and chewing at times. Is it possible it could be something else?
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Answered by Dr. Raju A.T 3 hours later
Brief Answer:
Edrophonium test

Detailed Answer:
Hi,

Thanks for the query.

Though tremors is not a typical symptom encountered in MG, it is not an exclusion. Symptoms most of times in MG are subjective.

Antibody test being negative when you have symptoms associated with ocular myasthenia does not rule out MG.

Have you got Edrophonium test done. This is one investigation considered reliable in cases like yours with negative antibodies and negative nerve stimulation tests. This is because the test elicits the presence of MG at the receptor level, it is where the disease starts first.

Do get the test to rule out or confirm the diagnosis.

Well, your symptoms do fit in for a neuromuscular disorder. I cant be sure whether MG without the test I mentioned.

regards,


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Raju A.T

General & Family Physician

Practicing since :2008

Answered : 4024 Questions

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