Myasthenia Gravis
Myasthenia Gravis is an autoimmune disease characterized by attack on the nerve-muscle junction. Myasthenia gravis involves weakness and fatigue of any group of voluntary muscles. This condition tends to worsen with activity and improves with rest. Muscles that are usually involved include those that control eyelid movement, facial expressions, swallowing and talking. Breakdown in the communication between muscles and nerves is caused by antibodies produced by the immune system. The production of these antibodies is believed to originate from the thymus gland.
Typical symptoms of MG include drooping eyelids, unstable gait or change in facial expressions. The patient suffering from Myasthenia gravis may experience fatigue on repetitive movements and muscle weakness in the limbs. There may be signs of double vision. Some patients suffer from slurred speech and difficulty in swallowing or speaking. In severe cases, neck muscles and muscles controlling breathing can be affected.
Often diagnosis of myasthenia gravis takes time since the symptoms are mistaken for those of other neurological disorders. Blood test to check for the presence of immune molecules or acetylcholine receptor antibodies aids in detectin any excessive levels of antibodies. The edrophonium test involves injection of edrophonium into the muscle to find out whether the cause for muscular weakness is MG. An EMG (electromyography) is used to diagnose myasthenia gravis by checking for impaired nerve-muscle transmission. Spirometry aids in assesing the respiratory function to check if the patient's respiratory muscles re affected.
Treatment for MG hinges on the patient's age and the muscles that are affected as well as severity of the muscle weakness. Myasthenia gravis can be controlled with medications such as immunosuppressive drugs and anticholinesterase agents. A surgical removal of the thymus gland helps in reducing symptoms in many patients suffering from Myasthenia Gravis. In severe cases of myasthenia gravis, Plasmapheresis is resorted to. Here, the blood of the patient is passed through a filter to remove some antibodies. Another form of therapy is to provide the patient with intravenous immune globulin to alter the response of the immune system.
Neuro Ophthalmologist
All vision problems need not necessarily stem from the eye. Some vision problems involve the brain. Neuro ophthalmology is the sub specialty of both neurology and ophthalmology. A neuro ophthalmologist is a phycian who specializes in the diseases affecting vision that originates from the nervous system. Conditions such as optic nerve disorders, loss of vision from central nervous system disease, double vision diplopia and involuntary movement of the eyes nystagmus are some of the disorders under the purview of a neuro ophthalmologist. An ophthalmologsit attends to patients with disease or injury in the eye ball, cornea and the lens or into the eyeball at the retina inside the eye. If any problem occurs behind the eye in the optic nerve or in some distinct visual pathways connecting the brain, it requires the special skills of a neuro ophthalmologist.
A neuro ophthalmologist could be an ophthalmologist or a neurologist with additional special training. After completing a residency program in any one of the two specialty areas, they take a fellowship in neuro ophthalmology for a year or two before starting to practice as a neuro ophthalmologist. A neuro ophthalmologist attends to a full spectrum of neuro opthalmic conditions including evaluation, diagnostic and referral services of rare and complex disorders. A neuro ophthalmologist caters to:
Patients who suddenly lose part of their side vision.
Patients suffering from double vision.
Patients with unequal pupils.
A patient suffering form a stroke.
A patient with brain tumor
Patients who suddenly have their vision out of focus
Any and every patient with unusual vision problems.
In addition to the above, a neuro ophthalmologist provides emergency evaluation of a wide variety of disease that can cause visual loss. Unexplained visual loss can arise out of uncommon disease conditions like myasthenia gravis, multiple sclerosis, mitochondrial disease and other muscular diseases that affect the eye. The neuro ophthalmologist uses special testing techniques including visual fields, visual evoked response, imaging studies such as CT, MRI and angiography and ultrasound to diagnose the disease patterns. It becomes necessary for the neuro ophthalmologist to work closely with other medical specialists to offer multidisciplinary care and solution for complex cases.
Electromyography
Electromyography or EMG is a diagnostic test that understands the physiological of muscles thereby assessing their health. Electromyography involves inserting a needle electrode through the skin into the muscle. This electorde detects electrical activity in the muscles and nerves controlling the muscles. A patient is asked to flex or contract the muscles so that the response of the muscle to the nerve stimuli is observed. An electromyograph is used to detect and measure electric potential that is generated by the contracting muscles. Other indicators to the proper functioning of the muscles and their corresponding nerves are the size, duration and frequency of electric signals received from them. EMG is often conducted along with a nerve conduction velocity test. The EMG test is used to diagnose any possible weakness or impaired muscle strength due to neurological problems. Some discorders that can lead to abnormal readings on EMG test are cervical spondylosis, myasthenia gravis, carpal tunnel syndrome, myopathy, Brachial plexopathy, Guillain-Barre syndrome, sciatic nerve dysfunction and mononueritis multiplex. EMG test aids in differentiating between a muscle and nerve disorder. The muscle may feel tender after the EMG test with localised bruising.
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