Myasthenia gravis hund

MYASTHENIA GRAVIS: DIAGNOSTIC TESTS

General Principles of Diagnostic Testing for MG

Rationale
- As thymectomy or long term immunotherapy may be necessary to treat MG, it is essential to establish a firm diagnosis
- A firm diagnosis avoids inappropriate treatments, and their side effects, in patients who do not have the disease.
Strategy of diagnostic testing
- As a general rule, a firm diagnosis is based upon
  - A characteristic history and physical examination, and
  - Two positive diagnostic tests, preferably serological and electrodiagnostic.
- Diagnostic investigations of MG should usually include both
  - Testing for serum anti-AChR antibodies
  - Repetitive nerve stimulation studies
Tensilon tests
- May be readily performed at the bedside
- Are not as sensitive, or specific, as the serological and electrophysiological studies
Single fiber EMG: Reserved for selected patients in whom other tests have been negative or equivocal.

Edrophonium (Tensilon) Testing
- Action
  - Inhibits acetylcholinesterase
  - Prolongs presence of neurotransmitter, acetylcholine, in the NMJ
  - Results in enhanced muscle strength
    - Duration: Lasts for a few minutes
    - Response
      - In patients with NMJ dysfunction
      - Not specific for MG
- Time course: Minutes; Rapid-onset; Short-acting

Method

Initially
- Dosing: 2 mg of edrophonium is administered intravenously as a test dose
- Monitoring heart rate: Bradycardia or ventricular fibrillation may develop
Follow-up
- After observing for about 2 minutes, if no clear response develops
- Up to 8 additional mg of edrophonium is injected
A double-blind protocol with a saline injection as placebo has been advocated
Testing should be performed with patient free of all cholinesterase-inhibitor medications
Cholinergic side effects of edrophonium
- May include increased salivation and lacrimation, mild sweating, flushing, urgency & perioral fasciculations.
- Atropine should be readily available to reverse effects of edrophonium in case of hemodynamic instability
- Extra precautions are especially important in elderly patients

Positive test

Most myasthenic muscles respond in 30 to 45 seconds after injection
Improvement in strength that may persist for up to 5 minutes
Requires objective improvement in muscle strength.
Subjective or minor responses, such as reduction of a sense of fatigue, should not be over interpreted

Utility of Tensilon test

Only useful in patients with objective, preferably measurable, findings on physical examination
Rarely helpful in the diagnostic evaluation of equivocal cases of MG
Sensitivity for MG is relatively low (60%) compared to other diagnostic tests
Tensilon testing should not be used to determine adjustments in the dose of pyridostigmine
False positive results
- Can occur in patients with LES, ALS or even localized, intracranial mass lesions
- Positive testing does not necessarily predict respose to a longer-acting anti-AChE drug

Serum antibodies vs Acetylcholine Receptors

AChR antibodies: General testing method
- Measurement using immunoprecipitation methodology
- Method: Human nicotinic AChRs from skeletal muscle labeled with 125 I-α-Bungarotoxin
Antibody properties & types
- Type: IgG₁-dominant
- Properties
  - Binding
  - Modulating
  - Blocking
  - vs AChR aggregates
  - Low affinity
- Targets
Antibody (IgG) targets in MG: Nicotinic AChRs
- α1-subunit of AChR
  - Typical myasthenia gravis
  - Epitope location: Main immunogenic region on extracellular tip of α1-subunit
  - Main immunogenic region (MIR) features
    - Cluster of overlapping epitopes
    - Conformation dependent
    - Also commonly a target of anti-AChR antibodies in Experimental autoimmune MG (EAMG)
    - Cross-linking
      - Single bivalent antibody cannot bind to both MIRs on same AChR
      - Antibodies can cross-link adjacent AChRs
    - Clinical correlation
- e -subunit
  - Acquired slow channel syndrome
  - Binding to Adult AChRs (containing e -subunit) 1
    - 13% of serums with no IgG binding to fetal AChRs
    - Increases finding (sensitivity) of anti-AChR antibodies in MG by
      3%
    - Occur in patients with either ocular or generalized MG syndromes
- γ-subunit
  - Neonatal MG (Transient
  - Arthrogryposis, Recurrent
AChR binding antibodies: Measurement of serum IgG (& IgM) antibodies that bind to AChRs
- Antigenic target
  - AChRs from human skeletal muscle: Mixed innervated & denervated, or
  - Myogenic cell line expressing both adult & fetal AChRs
- Clinical relevance
  - Relatively specific & sensitive test for MG
  - Other types of AChR testing (Modulating & Blocking): Low specificity
- Anti-AChR antibodies occur in
  - Adults with generalized MG: 85 to 90%
  - Childhood MG: 50%
  - Ocular MG: 50% to 70%
    - Lower titers
    - Bind best to adult AChRs with e subunit
  - MG and thymoma: Nearly 100%
  - Some patients taking penicillamine with or without MG
  - "False" positives
    - Thymoma without MG
    - Immune liver disorders
    - Older patients (> 70 years): 1% to 3%
    - Neuromyotonia
Antibody effects on AChRs: Other
- AChR Modulating Antibodies
  - Mechanism
    - Anti-AChR antibodies cross-link AChRs on the post-synaptic membrane
    - Endocytosis & degradation of AChRs are accelerated
  - Test results
    - May occur in a rare patient when anti-AChR antibody binding is negative.
    - MG: Usual loss = 20% to 90% of AChRs (Normal < 20%)
    - MG with thymoma: > 90% loss
    - False positives: Common
      - Low specificity for MG
      - Specific causes: Hemolysis; Muscle relaxant drugs; Serum heating
- AChR blocking antibodies: Block binding site for ACh on AChR (positive = 26% to 100% blocking).
  - Prevalence: Repeated arthrogryposis; 52% of generalized MG; 30% of ocular
  - 1% of patients with no binding or blocking antibodies
- Complement binding
  - Damage to postsynaptic membrane: Simplification of postsynaptic folds
  - Widening of synaptic cleft
Clinical correlations of MG & anti-AChR antibodies
- Absolute titer of AChR binding antibodies
  - Among patients: No relation with severity of MG
  - In individual patient: Improvement often seen with reduction in titer of > 50%
- Titer of antibody binding to main immunogenic region (MIR) of AChRs 2
  - Correlates with disease severity: Ocular vs Generalized
  - MIR location: Extracellular end of 2 α subunits of pentameric AChR
  - > 50% of MG AChR Abs bind to MIR
- Antibody blocking & modulation of AChRs
  - Some correlation with disease severity
  - Not diagnostically specific
- Neonatal MG: Transient
  - High anti-fetal/anti-adult muscle anti-AChR antibody ratio
- Recurrent arthrogryposis
  - IgG vs γ subunit of fetal AChR: Blocks AChR function
- Slow channel syndrome: Acquired
  - IgG vs adult AChR
- IgG vs Clustered AChRs 3
  - Present in
    - "Sero-Negative" ocular or generalized MG patients: 50%
    - AChR Ab+ patients: Many
  - Complement fixing
  - Antibody subclass: IgG₁
  - Associated with thymic pathology: Lymphocytic infiltrates; Germinal centers
- Neuronal AChR: α3 subunit
  - Autonomic PN (42%)
  - Isaacs (25%)
  - LEMS (12%)
- Also see: AChR disorders
Patients with MG but no anti-AChR antibodies
- Rule out hereditary MG
- Low frequency of thymic pathology & thymoma
- May have antibodies to other neuromuscular junction antigens

Repetitive Nerve Stimulation (RNS): 2 to 3 Hz

Repetitive Nerve Stimulation

Most frequently used electrodiagnostic test for MG
Nerve to be studied is electrically stimulated six to ten times at 2 or 3 Hertz
Compound muscle action potential (CMAP) is recorded with surface electrodes over muscle
Nerves tested
- At least one proximal & one distal motor nerve
- Innervation of weak muscles
If decrement present
- Repeat RNS: To ensure decrement is reproducible
- Test for: Post-exercise facilitation (Repair of decrement)
- Perform EMG
  - Rule out: Denervating disorder producing decrement
  - Look for: Small-short or Unstable motor unit action potentials supportive of NMJ disorder
If NO decrement at baseline
- Look for post exercise exhaustion: Appearance of decrement after exercise
- Perform: Single fiber EMG

RNS in Myasthenia Gravis

Normal muscles: No change in CMAP amplitude with repetitive nerve stimulation
Myasthenia gravis
- Progressive decline in CMAP amplitudes with the first 4 to 5 stimuli
  - Caused by failure (Block) of increasing number of NMJs
- Positive RNS test features
  - Decrement in CMAP amplitude
    - Size: More than 10% in reduction in CMAP amplitude
      - Measure from 1st to 4th or 5th potential in train
    - Smallest CMAP is often 2nd or 3rd potential in train
  - Post-tetanic potentiation (Post-exercise facilitation)
    - Definition: Reduction in (Repair of) decrement after exercise
    - Stimulus: Isometric exercise, brief (10 to 15 sec)
    - Time course
      - Onset: Immediate
      - Duration:
        2 minutes
    - Degree of repair: Partial or Complete
  - Post-exercise exhaustion
    - Definition: Post exercise appearance, or exacerbation, of decremental response
    - Protocol
      - Stimulus: Muscle exercise for 1 minute
      - Repeat RNS after 1, 2, 3 and 4 minutes
    - Time course
      - Onset: Maximal 3 to 5 minutes after exercise
      - Disappears by: 10 minutes after exercise
- RNS is positive in about 75% of patients with generalized MG, if:
  - Proximal & Clinically involved muscles are tested
  - Muscle is warm: Cooling reduces size of decrement
  - More than one muscle is tested: Strong muscles often have less decrement
- Diagnostic issues
  - Sensitivity of RNS for MG
    - Sensitivity in generalized MG
      - Overall: 75% to 80%
      - Increased
        
        Proximal & Clinically involved muscles are tested
        
        Muscle is warm
        
        More than one muscle is tested
      - Reduced
        
        Only distal muscles are tested
        
        Cooling: Reduces size of decrement
        
        Childhood MG
        
        Acute severe generalized or bulbar MG (≤ 4 weeks of disease): 11% to 40% positive 4
        
        Often have abnormal jitter
        
        Strong muscles: Often have less decrement
    - Ocular MG: 50%
  - Diagnostic specificity
    - A decremental response to RNS is not specific for MG
    - Decrements may also be seen in
      - Presynaptic disorders: Such as LEMS
      - Motor neuron diseases: Including ALS
      - Myopathies: McArdle's; Myotonia

Also see: Rapid RNS

Myasthenia Gravis Differential Diagnoses

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Diagnostic Considerations

Myasthenia gravis (MG) can mimic other diagnoses in elderly persons and vice versa. Examples of such pathology include diagnoses such as congestive heart failure, pulmonary embolism, and acute myocardial infarction.

Differential Diagnoses

Congenital Myasthenic Syndrome

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Contributor Information and Disclosures

Abbas Jowkar, MD, MBBS, PA-C Assistant Professor, Department of Neurology, Detroit Medical Center, Wayne State University School of Medicine

William D Goldenberg, MD Assistant Professor, Department of Emergency Medicine, Uniformed Services University of the Health Sciences; Staff Emergency Physician, Naval Hospital San Diego

Aashit K Shah, MD, FAAN, FANA Professor and Associate Chair of Neurology, Director, Comprehensive Epilepsy Program, Program Director, Clinical Neurophysiology Fellowship, Detroit Medical Center, Wayne State University School of Medicine

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Disclosure: Baxter Grant/research funds Other; Amgen Grant/research funds None

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Myasthenia gravis hund

Canine myasthenia gravis in dogs is quite a life-altering disease. It is a disease generating from poor immune system, where the immune system tends to attack the body instead of protecting it.

The life of myasthenia gravis dogs may not be as cheerful as healthy dogs. This is due to the fact that myasthenia gravis dogs tend to suffer from compromised immune system where the body is not able to recognize the bad elements from the good. Due to this reason, the internal organs of a dog can get damaged as the immune system finds them as dangerous, while in reality they’re not. Over time, canine myasthenia gravis may cause severe illnesses including muscle damages. It’s very important for a dog owner to treat his pet’s condition, as a progressed illness may bring about painful symptoms.

The symptoms of canine myasthenia gravis are quite many, and some of them are muscle degenerating and fatigue. Myasthenia gravis dogs often experience pain in the muscles and can feel tired very easily after doing some exercises. The affected muscles can also include the eye areas, where a dog may find it painful to move its eyelids. Canine myasthenia gravis may even cause damage to the facial muscles, and this may result in distortion of the face. The voice of myasthenia gravis dogs can be affected as well, as this disease may cause damage to the oesophagus area.

If myasthenia gravis dogs are taken to the vet, it would normally be given steroids or medications for relief. For short term purposes, it’s fine to supply myasthenia gravis dogs with drugs. However, canine myasthenia gravis can benefit the most from natural ingredients, as it takes time to chase the symptoms away from this illness. DigestaCure is one of the best natural products available on the market today. It does not only reduce the symptoms of myasthenia gravis in dogs, but it also combats the real cause of the illness for good. With regular use, canine myasthenia gravis symptoms can disappear for good.

Myasthenia Gravis in Dogs

Dr. Michael Richards

Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater.

Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum.

Myasthenia gravis is a neuromuscular disease in which weakness is the primary sign. This disease is caused by an inability of the certain nerve receptors (nicotinic acetylcholine receptors (AChRs) to function properly. This prevents the stimulus for muscles to contract which leads to the weak appearance. This disease occurs congenitally in some dog breeds. Jack Russell terriers, springer spaniels and smooth fox terriers are affected. It can also occur as an acquired problem in older dogs. In this case, it is thought to be an immune mediated disease. In older dogs, the first sign of problems may be megaesophagus -- enlargement of the esophagus due to the muscular weakness, leading to swallowing. This can cause regurgitation and lead to inhalation pneumonia.

Myasthenia gravis can be very variable in the way it looks. Only a few muscle groups may be affected or the dog may be nearly immobile. A dog can be almost normal after a rest and then lose strength very rapidly when it exercises at all.

Whenever megaesophagus is diagnosed, myasthenia gravis (MG) should be suspected. Conversely, whenever myasthenia gravis is diagnosed, chest X-rays should be done to evaluate the esophagus, in case megaesophagus is present.

MG can be presumptively diagnosed by a rapid response to injection of edrophonium hydrochloride (Tensilon). Dogs usually show an immediate improvement in muscle strength that is of short duration. Specific lab tests for this disease are available to confirm the diagnosis.

Dogs that acquire MG later in life usually have a fairly good prognosis with treatment. It is important to prevent aspiration pneumonia, so dogs should be fed from elevated food bowls and encouraged to remain standing for 10 minutes or so after eating. Anticholinesteras medications are very helpful. Pyridostigmine bromide (Mestinon syrup) is the most commonly used medication. If it is not effective, injections of neostigmine (Prostigmin) will sometimes work. In severe cases, corticosteroids may be necessary. It is very important to make sure that there are no other illnesses and no aspiration pneumonia signs prior to using corticosteroids.

Dogs can be maintained well for a long time with this disease. The more attention paid to prevention of aspiration pneumonia, the better the long term prognosis. In addition, many other medications interfere with the actions of the anticholinesterase drugs, so careful thought must be given to the choice of medications to treat other problems in dogs affected with myasthenia gravis.

A number of dogs with acquired MG will have remissions from the disease. Therefore, it is very important to monitor the antibodies to anticholinesterase receptors prior to treatment and at regular intervals during treatment. Recurrences of the disease after remission can occur, so vigilance is required throughout the lifespan of affected dogs.

Mike Richards, DVM

Myasthenia gravis and other possible problems

Question: Dear Dr. Richards: About three -four weeks ago, our ten year old female/spayed Golden Retriever became extremely upset during the middle of the night, jumping on and off the bed, trembling, panting heavily. Eventually, after several hours, she calmed back down and went to sleep. Subsequently, we started noticing symptoms, including that she was not blinking her left eye and the left eye seemed larger than the right. She also began having difficulty eating and drinking from her bowls and was panting excessively. Over the course of the next couple of weeks, I had to hand feed her canned dog food and she refused to eat any hard food or biscuits. I was also having to elevate her water dish up to her face where she still had a lot of difficulty lapping up the water. She paced alot inside with her tail between her legs and appeared to have difficulty getting comfortable, but for a time, seemed to be happy and wagging her tail out on walks. Her bark became extremely hoarse and she seemed to have some difficulty with the control over her mouth and tongue. Last week, she became extremely weak to the point that she was tipping over and we had to help lift her hind end up and down the two stairs to get out of the house for her walks. During this time, we saw our vet several times who thought that she was suffering from a brain tumor. All blood work and x-rays came back normal, however. We decided to wait a little bit to see if she would improve to determine whether she was suffering from a vestibular syndrome since we could not afford to have an MRI done at a cost of over $1000. Her symptoms, however, worsened to the point where she could not walk at all due to rear end weakness and had virtually stopped drinking and eating. As a result, we were forced to euthanize her this week. Since we are likely to get another Golden (although no other dog will replace our beloved, Teddy) I was wondering if you could answer these questions for my future reference: 1) Was it possible that she had something other than a brain tumor given the negative blood work and x-rays and, if so, were there other diagnostic studies other than an MRI that we should have looked into? 2) How pervasive are brain tumors in Golden Retrievers? (I subsequently heard from several other people that their Goldens also died from brain tumors; and 3) Are these tumors usually genetic, i.e., where a reputable breeder should know if there is a family history of this problem? Thank you very much. I spent a lot of time reading your site during this recent crisis and it was a big help. Sincerely, Julie

There are two disorders that I would have considered with the clinical signs that Teddy had.

The first is myasthenia gravis. This disease is characterized by neuromuscular weakness and is a close fit for the symptoms that you observed. Early in myasthenia gravis there is a tendency for subtle to fairly noticeable weakness of one or more legs. When dogs with this disease are tired they may have drooping of the facial muscles and it is not uncommon for there to be oculomotor problems, as well. Voice changes are also not uncommon with myasthenia gravis. This is an acquired immune mediated disorder most of the time when it occurs in older dogs. It is more common in large breed dogs, with German shepherds supposedly being the most commonly affected breed. In our practice, though, golden retrievers seem to outnumber the other breeds with this problem. This may just be a local variation in our area, however. Testing for this disease can be done tentatively by administration of a medication, edrophonium chloride (Tensilon Rx) and watching for nearly immediate improvement in clinical signs which then rapidly return as the medication wears off after five to ten minutes. If this testing seems to indicate that the disease is present, it can be confirmed through serum testing and sometimes through muscle biopsy. Myasthenia gravis may respond reasonably well to medical treatment, based on the information in the literature, but this is definitely not always the case.

The other condition that I thought of, but think is much less likely, is severe hypothyroidism. I suspect that this was probably tested for in the lab work that was done, though. Hypothyroidism has been linked with facial paralysis, laryngeal paralysis, muscular weakness and a number of other signs. When hypothyroidism becomes severe, it sometimes causes a "tragic" expression on a dog's face due to facial edema.

Brain tumors are supposed to represent about 1 to 2% of the natural causes of death in dogs, so that is between 1 in 100 and 1 in 50 dogs. There is a lot of variability in the suspected heritability of different brain tumors and in many (most?) cases it is not known with certainty if the tumors are inherited. Without a post mortem examination which identified a brain tumor, it is hard to say if one was really present. I think that many instances of suspected brain tumors might turn out to be other things if post mortem examinations were done -- and that there would also be a lot of cases in which a tumor was not diagnosed when one was actually present.

I think that golden retrievers are more prone to lymphomas than other dog breeds even though I can not recall seeing proof of this in the veterinary literature. I would ask a breeder whether this tumor had been a problem in the breed line, though. Hemangiosarcomas may also be more common in this breed than in many other breeds but that is also just a personal observation.

It is important to understand that actually seeing and examining a pet allows some possible diagnoses to be ruled out even though they sound like they may be present based on clinical signs. Your vet had the opportunity to make this kind of an examination, so even though myasthenia gravis seems very possible based on the signs you describe, your vet may have good reasons for believing it was not present.

Mike Richards, DVM 5/22/2001

My dog Jake 100 lb. Shepherd X Husky age 8 has been diagnosed with Myasthenia Gravis. He was on Mestinon for about 5 weeks and it seems to be in remission! (whew) But the poor guy has some sort of bacterial rash from swimming in the lake all over his body, he's lost some fur, has large flakes, rash, redness, itching etc. Today while brushing his belly I noticed a thick yellow discharge from his penis! The Vet tried in this order 1. Amoxiclian 2. Medicated bathes 3.Prednizone 4. Skin and Coat liquid supplement 5. Wysong Anergen What more can we do.

Thanks in advance!

Lisa PS. I love your site.

The discharge from the prepuce is probably normal. There is a thick exudate, referred to as smegma, which is thick yellow to yellow-green in color and is normal. For some reason, it may seem to suddenly accumulate in larger quantities in some dogs. This may also relate some to the overall skin condition.

The skin rash might be a drug reaction. Some patients are reported to be sensitive to pyridostigmine bromide (Mestinon Rx) but I haven't actually seen skin rash listed as a side effect, just cautions about using this medication in patients who are sensitive to it. Still, if this rash started after you started using pyridostigmine, it would definitely be worth considering. It may be possible to withdraw pyridostigmine in the future, which would be helpful if it is the cause of problems. It is acceptable to use pyridostigmine in conjunction with corticosteroids or azathioprine (Imuran Rx), which are immunosuppressive medications and might help with a drug reaction. Of course, it is possible that this is a primary skin infection and that antibiotics or anti-fungal medications (for yeast infections) may be necessary to control it. In that case, immunosuppressive medications would not be advisable. Since it is hard to be certain a drug reaction is occurring we often try the antibiotics first and other medications only if they aren't helpful. A skin biopsy can be helpful in determining what is happening and in complicated cases like yours, we try to do them early on since the trial and error approach can take some time. Another immunosuppressive medication that has sometimes been helpful in combination with Mestinon is mycophenolate (Cellcept Rx). This is a relatively expensive choice, though.

Hope that this helps some.

Mike Richards, DVM 11/21/2000

Myasthenia gravis in young Mastiff possible

Last Saturday (4/8), it became extremely difficult for our male Mastiff (11 months old) to walk -- even with assistance. His condition developed suddenly and without any trauma. We took him to an emergency veterinary hospital; however, the Vet was unable to diagnosis the problem. Vital signs, blood work, and x-rays all appeared normal. He does not seem to be in any pain. Occasionally, he would try to get up, but only collapsed. His condition remains about the same today, almost a week later.

He saw our regular Vet on Monday, 4/10. After examining him, our Vet placed him on Primor, and referred him to a Internal Medicine specialist.

He was seen by the IM Specialist on Tuesday, 4/11. The specialist performed a spinal tap and additional test of the serum. Spinal fluid was normal. Serum test ruled out tick borne diseases. Although the dystemper test was negative, the specialist cautioned that this does not rule dystemper out. We are still waiting for the results of the test for NEOSPIRA CANINUM. Since his condition was not improving, the Specialist recommended that our Vet change his prescription from Primor to Clindamycin (750mg 2xDay). This change took place on 4/13.

He seemed to perk up a little last night (4/13), but began vomiting today (Fri 4/14). Our Vet is treating him to prevent the vomiting.

Would appreciate any advise, or comments.

My first thought on reading your note was that your mastiff might have myasthenia gravis. There is a pretty high correlation between myasthenia gravis and megaesophagus in dogs, which is commonly associated with vomiting and the weakness would be typical of this. There can be acute onsets of this disease. There is a serum test for myasthenia gravis and a test using administration of Tensilon (Rx), which usually causes rapid, but brief, improvement in clinical signs.

Polyradiculoneuritis seems possible, too. This is paralysis that usually starts in the rear legs and then progressively worsens. It is similar to Guillain-Barre syndrome in humans. I don't know how to definitively diagnose this condition but a veterinary neurologist may be able to. Tick paralysis and acute idiopathic polyneuropathy are similar problems that might be present.

The only other things I can think of, offhand, are heart problems, such as Cardiomyopathy, and hypoadrenocorticism. Usually the onset of signs is much slower with cardiomyopathy and the persistence of signs much less chronic with hypoadrenocorticism, though.

I would worry the most about myasthenia gravis since early treatment may make it possible to avoid severe complications associated with megaesophagus development. It is likely that your vet and/or the specialist have considered this disease but it wouldn't hurt to ask about it.

Mike Richards, DVM 4/18/2000

Test for myasthenia gravis

Q: Dear Dr. Richards. An entire online Mastiff list has been trying to help us because we are so desperate. Our 13 month old Mastiff puppy has had symptoms of collapsing and seizure-like episodes after exercise. He has always been exercise intolerant. We have been to 5 vets, two Internal Med specialists and a cardiologist. The last specialist mentioned a list of possible more tests to run since we keep coming up emptyhanded. and the test for Myasthenia Gravis was one of them. I had no idea what this was so I came home and asked my mailing list. They directed me to several websites including yours and the symptoms listed fit my Mason's symptoms to a TEE. Can you tell me what I need to do to find out for sure if he has this. I heard it's some kind of blood screening, but I want to be exactly sure what to do so that we leave no stone unturned. I hope you can help me! Thank you. Regards Kristen

The test for myasthenia gravis is done on serum. It must be sent chilled by overnight mail so the arrangements have to made in advance and the sample sent on a day when next day delivery is available. Dr. Diane Shelton is the only person I know running the test. Her address is:

Diane Shelton UCSD School of Medicine Basic Science Building Room B200 La Jolla, CA 92093-0614 619-534-1537

It would be best to have your vet contact her to make any arrangements so that there are no mix-ups in the communications. Please don't post her address on a mailing list or bulletin board unless she says it is OK after contacting her.

Good luck with this.

Mike Richards, DVM

Myasthenia gravis and other possible problems

There are two disorders that I would have considered with the clinical signs that Teddy had.

Mike Richards, DVM 5/22/2001

Thanks in advance!

Lisa PS. I love your site.

Hope that this helps some.

Mike Richards, DVM 11/21/2000

Myasthenia gravis in young Mastiff possible

He saw our regular Vet on Monday, 4/10. After examining him, our Vet placed him on Primor, and referred him to a Internal Medicine specialist.

He seemed to perk up a little last night (4/13), but began vomiting today (Fri 4/14). Our Vet is treating him to prevent the vomiting.

Would appreciate any advise, or comments.

Mike Richards, DVM 4/18/2000

Test for myasthenia gravis

Diane Shelton UCSD School of Medicine Basic Science Building Room B200 La Jolla, CA 92093-0614 619-534-1537

Myasthenia Gravis

Click on a topic from the list below to find out more about Myasthenia Gravis:

What is it? Myasthenia Gravis (MG) is a neuromuscular autoimmune disease that affects the use of muscles – normal communication between the nerve and the muscle is interrupted, leaving the muscle weak and fatigued. To find out more click here.

Causes. In MG, the receptors at the muscle surface are destroyed or deformed by antibodies that prevent a normal muscular reaction from occurring. To find out more click here.

Symptoms. At one time the myasthenic may function normally, and at another time experience severe loss of strength. Others may think that the myastenic is lazy, or that they are suffering from a psychological problem. To find out more click here.

Diagnosis. The symptoms of Myasthenia Gravis (MG) are common complaints across a variety of medical conditions. This makes it difficult to diagnose MG, particularly in cases where the condition is mild, or where the physician is not familiar enough with the condition to suspect the condition. To find out more click here.

Treatments. Myasthenia Gravis (MG) is no longer considered a fatal disease. Most myasthenics, with the help of either drugs and/or surgery, lead near-normal lives. However, there is no standard therapy for all myasthenics. To find out more click here.

History. Thomas Willis (1621-1675) – an English physician, published the book “De anima brutorum” in 1672 in which he wrote about a woman who temporarily lost her power of speech and became “mute as a fish”. This has been interpreted as being the first written description of myasthenia gravis. To find out more click here.

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Myasthenia gravis hund

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Myasthenia gravis (MG) literally means grave (gravis) muscle (my-) weakness (asthenia). It is a common cause of generalised weakness in dogs and occasionally cats.

What is myasthenia gravis?

Each muscle in the body is controlled by its own nerve, but this nerve does not connect directly to the muscle. At the junction between the nerve and the muscle (also known as the neuromuscular junction) there is a small gap. Signals travel along the nerve as an electrical current. When the electrical nerve impulse reaches the end of the nerve, the signal must be conveyed across the gap to the muscle.

What causes myasthenia gravis?

Animals with congenital MG are born with too few acetylcholine receptors. The acquired form is caused by a faulty immune-system. The main role of the immune system is to protect the body against infection or foreign invaders, and this is often done by the production of antibodies. In acquired MG, the immune system produces antibodies (called anti-acetylcholine receptor antibody or AChR antibody) which attack and destroy the acetylcholine receptor. No-one really knows why the immune system should suddenly decide to attack these receptors in some dogs. In rare cases, myasthenia gravis in dogs and cats can be triggered by cancer, be associated with other immune diseases affecting the nerve or muscle, or be related to an under-active thyroid gland.

How do I know if my pet has myasthenia gravis?

The typical picture of myasthenia gravis in dogs and cats is severe weakness after only a few minutes of exercise. This weakness might affect all four legs or only affect the back legs. It is frequently preceded by a short stride stiff gait with muscle tremors. As soon as an affected animal rests they regain their strength and can be active for a brief period before exercise-induced weakness returns.

How will my vet know my dog has myasthenia gravis?

Sometimes the diagnosis of MG can be simple but in other animals it is not straightforward. The best test to diagnose acquired myasthenia gravis in dogs and cats is a blood test which looks for antibodies directed toward the acetylcholine receptor. (anti-AChR antibody titre).

Your vet may need to do other tests to re-enforce their suspicion of MG. One of these is the 'Tensilon test' - in this test a short-acting antidote to MG (tensilon) is injected into a vein. In affected animals, there will be a dramatic increase in muscle strength immediately after injection and collapsed animals may get up and run about (however the effects wear off after a few minutes).

Diagnosis of the rare congenital form of myasthenia gravis in dogs and cats is based on a special analysis of a muscle biopsy.

Other investigations may be required to look for underlying causes of the disease, particularly in older animals. Chest X-Rays can be indicated to look for cancer in the chest cavity and to evaluate possible involvement of the oesophagus and to detect pneumonia secondary to inhalation of food.

Can myasthenia gravis be treated?

Specific treatment of MG is based on giving a form of long-acting antidote. This improves the transfer of the signal from the nerves to the muscle. Depending on individual circumstances, it may be necessary to give drugs that will suppress the system to stop it attacking the receptors. If your dog has pneumonia your vet will want to treat that first (with antibiotics and other drugs) before suppressing the immune system.

Will my pet get better?

Prognosis is generally good for a complete recovery unless severe pneumonia, severe difficulty eating or underlying cancer is present. Treatment of myasthenia gravis in dogs and cats usually lasts many months and your vet will need to re-examine your pet on a regular basis to check that they are improving. Repeated blood test to measure anti-AChR antibody levels will also be required.

Myasthenia gravis can be a very serious disease. However with an early diagnosis and a high level of care, your pet may make a full recovery.

If you are concerned about the health of your pet you should contact your veterinary surgeon.

Myasthenia Gravis in Dogs

Myasthenia gravis is a disorder affecting our canine friends. It is caused by a breakdown of the transmission of impulses from the nerves to the muscles. This keeps the muscles from contracting, causing affected dogs to become weak—the number one symptom of this neuromuscular disease.

Though rare, myasthenia gravis can be an inherited congenital defect that pups are born with. Some breeds at risk for the congenital form are Jack Russell terriers, springer spaniels, and smooth fox terriers. More commonly, myasthenia gravis is an acquired problem in adult dogs that is thought to be the result of a defect in a dog’s immune system caused by antibodies that mistake the dog’s muscle receptors as “bad guys,” attacking them and preventing them from working properly.

Both female and male dogs are equally at risk, and all breeds are susceptible to this disease. Dogs that acquire mild forms of this disease later in life have a fairly good prognosis, so long as they receive proper, timely treatment.

Symptoms of myasthenia gravis can vary greatly from dog to dog. The most common symptom is muscle weakness that worsens with exercise but improves with rest. Often the esophagus is affected, and dogs have trouble swallowing and drinking. They may also regurgitate food. In some situations, affected dogs aspirate food and water, which can result in pneumonia.

If your pet suffers from muscle weakness, your veterinarian will take a thorough history and perform a complete physical exam on him.

There are many things that can cause muscle weakness in dogs; therefore, your veterinarian may recommend diagnostic tests such as:

Chemistry tests to evaluate kidney, liver, and pancreatic function, as well as sugar levels
Blood parasite screening to identify if your pet has been exposed to tick-borne or other infectious diseases
Fecal tests to rule out intestinal parasites
A complete blood count (CBC) to rule out blood-related conditions
Electrolyte tests to ensure your pet isn’t dehydrated or suffering from an electrolyte imbalance
Urine tests to screen for urinary tract infections and other diseases, and to evaluate the kidney’s ability to concentrate urine
A thyroid test to determine if the thyroid gland is producing too little thyroid hormone
X-rays of the chest, abdomen, and spine
Myelogram contrast x-rays of the spine (dye is injected into the spinal column, then x-rayed)
MRI or CT scan to gain a detailed picture of the brain and spine
Specialized immunologic tests, including titers
A Tensilon test, which checks muscle response

If your four-legged friend is diagnosed with myasthenia gravis, your veterinarian will tailor your dog’s treatment specifically to his needs. Treatment may include the use of anticholinesterase drugs. These help to improve muscle strength by reducing the antibodies’ attack on muscle receptors, allowing the muscles to work better. Because dogs with myasthenia gravis have a poorly functioning esophagus, they need to eat or be fed carefully. Make sure that your dog’s head is elevated during feeding and for 10–15 minutes afterward. Pneumonia can be a very serious side effect of any disorder that impacts a dog’s ability to swallow correctly. Your veterinarian will work with you to identify the best way to make sure your dog can eat and drink without the risk of regurgitation or aspirating food/water.

Unfortunately, there is no prevention or cure for this disease. Treatment and vigilant at-home care can help dogs with this disease maintain a quality life for a long time. The more attention paid to the prevention of aspiration pneumonia, the better the prognosis.

If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.

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Myasthenia Gravis Center - Fargo, ND

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четверг, 14 июня 2018 г.

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MYASTHENIA GRAVIS: DIAGNOSTIC TESTS

General Principles of Diagnostic Testing for MG

Edrophonium (Tensilon) Testing

Serum antibodies vs Acetylcholine Receptors

Repetitive Nerve Stimulation (RNS): 2 to 3 Hz

Repetitive Nerve Stimulation

Myasthenia Gravis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Contributor Information and Disclosures

Myasthenia gravis hund

Myasthenia Gravis in Dogs

Dr. Michael Richards

Myasthenia Gravis

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