Suggest treatment for neuromuscular junction disorder after a car accident

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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
doctor
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
doctor
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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
doctor
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
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3793 Questions

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