Myasthenia gravis is an autoimmune, neuromuscular disorder.   Myasthenia gravis causes weakness and/ or fatigue of any voluntary muscle.  Ususally swallowing, facial expression, and movement of eyes are affected by myasthenia gravis.  Long-term treatment is oral medications that include corticosteroids.  When a person is in a myasthenic crises, they may not be able to swallow or have difficulty breathing.  A quick solution must be found to reverse a myasthenic crises or death may quickly occur.

When myasthenia gravis occurs, neuromuscular transmission is disrupted because of decreased receptor numbers.  The decrease of receptors is a result of binding antibodies to nicotinic acetylcholine receptors located on the post-synaptic membrane of the neuromuscular junction.  As many as 30-95% of myasthenia gravis patients are seropositive for immunoglobulin G AChR antibodies.  If a person receives treatment by plasmapheresis and a decrease in the antibody titre occurs, the symptoms will improve and short-term relief is achieved until the plasma antibodies rise again.

(Plasmapheresis is the process of removing the plasma and antibodies from whole blood.  RBC are returned to the body.  The process typically occurs in about an hour and saline is administered to replace the fluids lost through the apheresis process.)

Using plasmapheresis to remedy a life-threatening event such as myasthenic crises makes the process affordable and a reality for those suffering from myasthenia gravis.  The industry of plasmapheresis has so much to offer our evolving biologics research and treatment world through the process itself and through its use in pharmaceuticals.  Many studies are using the immunoglobulins from refracted plasma to build new medication therapies for chronic illnesses.  Plasmapheresis is a popular way to obtain life saving immunoglobulins that can be given in forms of medication or transplanted directly to patients to remedy sickle-cell crises and burns.  Maybe in the future studies and new technology of the apheresis process could include a way to give myasthenia gravis a periodic (daily, weekly) treatment for long-term needs.

Works cited:

“Myasthenia gravis”, Mayo Clinic Staff.  mayoclinic.com http://www.mayoclinic.com/health/myastheniagravis/DS00375.  26 JUN 2013, 11:14pm.

“Treatment Alternatives in the Successful Management of Myasthenia Gravis”.  Drugs and Therapy Prospectives, Medscape News Today.  27 Jun 2013,  7:53 am.  http://www.medscape.com/viewarticle/434482.

Tourette’s Syndrome (TS) is a chronic neuropsychiatric disorder.  There are no two TS patients with the same set of symptoms that include simple and complex motor and vocal tics.  There are also differences in duration and severity of the tics.  Simple motor tics usually affect only one muscle group and complex motor tics are more abrupt and affect simple movement and coordinated sequences of movement.  Intractable TS patients have many complex motor tics and are found to be harmful to themselves if they are great in severity.

After careful evaluation of TS patients, their outcome of problem severity and resulting impairment, some patients may be candidates for neurosurgical treatment called a bilateral limbic leucotomy.  The surgery entails making lesions in the lower medial quadrants of the frontal lobes in the brain.  One patient showed progress with reduction of symptoms within 2 days of surgery and compulsions disappeared within 6 weeks.  The patient is then no longer a damger to themselves and can live a more normal lifestyle, with much less degree of syndrome symptoms.

With the many neurosurgical advances in the medical world and the new knowledge of the syndrome’s physiology we can see that there are promising outcomes from surgical techniques.  All patients with chronic illnesses need treatment plans with realistic outcomes to meet their basic needs of daily life.  The bilateral limbic leucotomy has now shown that severe Tourette’s symptoms can be alleviated through manipulation of the frontal lobes.  Hopefully this will not be a costly procedure as it evolves to a process performed more often and possibly to help alleviate more minor syndrome patients with further studies.

Works Cited:

http:www.hopskinsmedicine.org/conditions/nervous sytem.html

“The treatment of Guilles de la Tourette syndrome by limbic leucotomy”, M Robertson, M Doran, M Trimble, AJ Lees. Journal of Neurology, Neurosurgery, and Psychiatry 1990; 53: 691-694.

Anatomy and Physiology: The Unity of Form and Function, 5th ed: Saladin. McGraw-Hill, New York 2010.