Case of Myasthenia..

[FaddyAcids]

I dont know if its allowed to post personal questions in here, but any replies would be greatly appreciated.

My 70 yr old grandmother complains of diplopia and ptosis that worsens at night. Neurological examination was unremarkable. Brain CT and MRI haven't revealed any serious lesion except some senile changes. The Neurologist prescribed Mestinon (Pyridostigmine) with no improvement! Then he wanted us to do some tests (Anti-Ach receptor and EMG) .

Besides an ophthalmologist has found different ocular muscles affected everytime she sees him, made her 3 different glasses and she still sees double though!!


1. How come didn't she get any better on Mestinon if she really has Myasthenia? Isn't it the only treatment? with cyclosporine?

2. Does Myasthenia explain the alteration of ocular muscles affection?

3. What should we be doing now? Do the tests? Or is it going to be worthless?


Thanks a lot.

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[NR117]

1. She didn't get better because Mestinon works far better for ptosis than it does for diplopia. Prednisone works better for the latter.

2. Absolutely. Variability in pattern of extraocular motility defect is highly suspicious for myasthenia.

3. I would check Ach receptor antibodies and do single fiber EMG. I think she should see a neuro-ophthalmologist, though...

 

[FaddyAcids]

Thanks a lot doc. That makes things clear to me, appreciate your help!