Suggest treatment for neuromuscular junction disorder after a car accident

Posted on Mon, 25 May 2015 in Headache and Migraines
Question: My wife was in a car accident in January. She suffered numerous issues ( whiplash, concussion, back strain, shoulder separation, but most notably potentially ocular myasthenia gravis
She left eye has ptosis.95% closed. She has a lack of frontal is contraction suggesting involvement of 2 cranial nerves( a partial VII and partialVIII) or a neuromuscular junction disorder such as MG. she was given mestinon 30mg but has been increased to 60mg 3 times a day. This has brought her eye up 85%, but will drop back down without the medication. She went to sunnybrooke hospital for a single fibre EMG and told not to take mestinon that day. The test could not gather results as the frontalis would not trigger.
Due to the fact the mestinon is working would that not confirm she has Myasthenia gravis brought on by the serious trauma of the car accident. If not what else could it be
Answered by Dr. Erion Spaho 52 minutes later
Brief Answer:
Tests evidence needed to confirm Myasthenia Gravis.

Detailed Answer:
Hi and thanks for using HCM.

I have read your question and understand your concerns.

Myasthenia Gravis is a neuromuscular disease that affects not only one muscle, but several muscles groups causing progressive weakness especially after prolonged muscle use.

Ptosis ( or eye closed) is related 70% with third cranial nerve damage and 30% with cervical sympathetic ganglion or sympathetic nerves damage.

Improvement of ptosis by Mestinon (Pyridostigmine) use could be related to sympathetic/parasympathetic nervous system equilibrium involvement.

There are just few cases reported in literature about Myasthenia Gravis precipitated by trauma, in these cases, tests are needed to confirm the diagnosis.

Other tests, besides single fiber EMG that failed because of Mestinon, are needed to confirm or exclude diagnosis and these include ice pack test, blood test about abnormal antibodies against receptors, Tensilon ( Edrophonium) test.

Getting these tests done, should be discussed with a Neurologist.

If these tests result negative about MS, your wife's symptoms are caused by trauma and contused cranial nerves.

Hope this answers your question. If you have further questions, feel free to ask.
If not, you can close the conversation and rate the answer. Wishing both of you good health.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Erion Spaho 34 minutes later
Thank you but I am still confused on how the mestinon works on a injury of cotused cranial nerves. As the eye and frontalis shutdown without the medication.
If they can't get a positive result are we to assume that time will heal her and eventually she won't have to take the mestinon and her double vision will cease
Answered by Dr. Erion Spaho 4 hours later
Brief Answer:
Mestinon helps better functioning of neuromuscular junction.

Detailed Answer:
Hi again, and thanks for asking back.

Mestinon ( Pyridostigmine) increases acetylcholine ( a neurotransmitter ) levels at neuromuscular junction, promoting better muscular function.

Nerves and muscles are not damaged entirely, only partially by trauma, except cases of evidenced total cut.

Mestinon promotes a better functionality of these remaining neuromuscular units.

As I said before, other tests to exclude or diagnose Myasthenia Gravis should be done.

If Myasthenia Gravis is excluded, we can look forward to an improvement of ptosis and double vision.

Hope I've been understandable.

Best regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Answered by
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3793 Questions


The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,  
Medical Topics ,  

Recent questions on  Double vision

doctor1 MD

I am a 34 yo female, healthy except for some odd issues over the years. At 20 I had about a weeklong migraine (no prior instances), followed by...

doctor1 MD

hi sir. i had headache and earpain.for almost one year.i had consulted doctor n they told as obstructive hydrocephalus..and did vp shunt...

doctor1 MD

Morning Doc, My Age is 27 and I m Male.I recently underwent acute sub dural hematoma surgery left frontal one month ago by using Burr hole...

doctor1 MD

I have double vision and during the Night I feel numbness and swelling in both hands I have also often had. I controlled over my arms And have hit...

doctor1 MD

I got real dizzy and kinda lost tempory balance and experienced double vision but only for 30 seconds, twice yesterday. I am in good health at 78...

doctor1 MD

I have high blood presser and high blood suger I am taking meds but now have times were a'm having double vision that when I drink a soda it gose...

doctor1 MD

Hi my head feels heavy I left work early and slept for 3 hours what causes this ? I’m healthy

Get personalised answers from verified doctor in minutes across 80+ specialties

128 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction