Observation of a Case of Autoimmune Anti-rach Myasthenia Gravis: Clinical Aspect and Management at the West Guyanese General Pediatrics Department
Bangoura K1,3*, Diallo FB2, Diallo ML2, Camara SH2, Conde I2 and Kouyate M2
1Pediatric Ward, West Guyanese, Guinea
2Pediatric Ward, CHU Donka, Guinea
3Gamal Abdel Nasser University Conakry, Guinea
*Corresponding Author: Bangoura K, Pediatric Ward, West Guyanese, Guinea.
November 03, 2022; Published: November 22, 2022
The objectives of this observation were to describe the elements of the positive diagnosis and to evaluate the evolution under treatment of a case of myasthenia gravis antis rach autoimmune in a 17-year-old girl who had made several visits to the emergency room for walking disorder on background. weight loss and physical asthenia.
Myasthenia gravis is an autoimmune disease of the neuromuscular junction which preferentially affects young women and the elderly and whose incidence is tending to increase. Fluctuating oculo-facio-bulbar paresis of varying severity is common. Remissions and exacerbations are typical. The disease is caused by autoantibodies directed against acetylcholine receptors or more rarely against a specific muscle kinase. The therapeutic objective, mainly based on observational studies, is that of a remission which is obtained by continuous collaborative work between the attending physician and the specialized center, by the combination of symptomatic drugs (anticholinesterases) and immunomodulators/suppressants (prednisone and azathioprine), or even other alternative treatments.
Complementary examinations aim to confirm the diagnosis and to look for associated pathologies (1/10 to a thymoma or an associated autoimmune disease). The assessment includes immunological assays for autoantibodies, mainly anti-RACh or anti-MuSK antibodies, electromyography and repeated nerve simulations, thoracic imaging (75% of patients have thymic hyperplasia and 15% thymoma). A Tensilon pharmacological test, performed in a hospital setting, can confirm the diagnosis.
Keywords: Myasthenia Gravis; Antis Rach; Autoimmune Child
- Bouchikh M., et al. “Thymoma-associated myasthenia gravis: Clinical features and surgical. Results”. Revue Neurologique 169 (2013): 879-883.
- Kaplan AA. “Toward the rational prescription of therapeutic plasma exchange: The kinetics of immunoglobulin removal”. Seminar on Dialysis 3 (1992): 227-229.
- Bird “Treatment of myasthenia”. Up to Date (2013).
- , et al. “Myasthenia gravis. A manual for the health care provider, Myasthenia Gravis Foundation of America”. (2008).
- , et al. “Myasthenia gravis crisis”. Southern Medical Journal 101.1 (2008): 63-69.
- Gold R and Schneider-Gold C. “Current and future standards in treatment of myasthenia gravis”. Neurotherapeutics 4 (2008): 535-541.
- , et al. “Comparative analysis of therapeutic option used for myasthenia gravis”. Annals of Neurology 68.6 (2010): 797-805.
- Drachman DB. “Myasthenia gravis”. The New England Journal of Medicine 25/81994): 1797-1810.
- Eymard B. “Antibodies in myasthenia gravis”. Revue Neurologique 165 (2009): 137-143.
- Eymard B. “Myasthenic syndromes”. The Neurologist's Letter1/2 (2015): 1-12.
- Heckmann JM., et al. “Myasthenia gravis in South Africans: racial differences in clinical manifestations”. Neuromuscular Disorder11-12 (2007): 929-934.
- Gadjos P., et al. “Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis”. Annals of Neurology 41 (1997): 789-796.
- Gaumond MC. “Ocular disorders of myasthenia”. EMC-Neurology (2005): 544-556.
- Abib M., et al. “Basedowian myasthenia and hyperthyroidism: about a case”. Tunisie Médicale 67 (1989): 731-733.
- Alan S and Josephon MD. “Autoantibodies and the autoimmune diseases”. Bulletin of the New York Academy of Medicine 7 (1981): 631-637.
- Budde JM., et al. “Predictors of outcome in thymectomy for myasthenia gravis”. The Annals of Thoracic Surgery 1 (2001): 197-202.
- Chenevier F., et al. “Myasthenia and myasthenic syndromes”. Elsevier Masson (2011).
- Lopez-Cano M., et al. “Clinical and pathologic predictors of outcome in Thymoma-associated myasthenia gravis”. The Annals of Thoracic Surgery5 (2003): 1643-1649.
- Magy L., et al. “Thymoma-associated myasthenia gravis: outcome, clinical and pathological correlations in 197 patients on a 20-year experience”. Journal of Neuroimmunology2 (2008): 237-244.
- Ojini FI., et al. “Clinical manifestations of myasthenia gravis- review of cases seen at the Lagos University Teaching Hospital”. The Nigerian Postgraduate Medical Journal3 (2004): 193-197.
- Romi F. “Thymoma in myasthenia gravis: From Diagnosis to Treatment”. Autoimmune Disease 11 (2011): 474-512.
- Ekenze OS., et al. “Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu”. Nigerian Medical Journal4 (2010): 419-422.
- Niks EH., et al. “Decremental response of the nasalis and the hypothenar muscles inmyasthenia gravis”. Muscle Nerve 28 (2003): 236-238.
- Tranchant C. “Therapeutic strategy in Myasthenia”. Revue Neurologique 165 (2009): 149-154.
- Miladi M. I., et al. “Contribution of plasma exchanges in the treatment of myasthenia gravis: study of 11 cases”. Revue de Médecine Interne 29 (2008): 87-93.
- Pruijm M. T., et al. “Plasmapheresis: technique and complications”. Rev Med Switzerland 25 (2008): 581-588.
- U** Heininger JF. “Seward Varicella”. The Lancet 368 (2006).