Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- fuerza muscular fatiga
- ptosis
- diplopía
- disfagia
- disartría
- paresia facial
- debilidad en las extremidades proximales
- disnea
Factores de riesgo
- antecedentes familiares de trastornos autoinmunes
- marcadores genéticos
- tratamiento dirigido contra el cáncer
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- análisis sérico de anticuerpos frente a los receptores de acetilcolina (AChR)
- anticuerpos frente a la tirosina cinasa específica del músculo (MuSK)
- pruebas funcionales respiratorias en serie
Pruebas diagnósticas que deben considerarse
- ensayos de anticuerpos contra el receptor estriado
- estimulación nerviosa repetitiva
- electromiograma (EMG) de fibra aislada
- tomografía computarizada (TC) de tórax
Algoritmo de tratamiento
crisis miasténica
enfermedad de leve a moderada (clase I a III)
enfermedad grave (clase IV o V) o refractaria
Colaboradores
Autores
Robert P. Lisak, MD, FRCP (E), FAAN, FANA
Parker Webber Chair in Neurology
Professor of Neurology
Professor of Immunology and Microbiology
Wayne State University School of Medicine
Detroit
MI
Divulgaciones
RPL currently serves on an Advisory Board for Argenx for myasthenia gravis (MG), and was an Advisory Board member for Argenx (developing a clinical trial for chronic inflammatory demyelinating polyneuropathy [CIDP]). RPL has been reimbursed by Argenx the manufacturer of efartigimod for serving on a clinical advisory board. RPL has worked with Alexion (testing a treatment for MG); Novartis (design of research related to primary progressive multiple sclerosis [MS] vs. secondary progressive MS); Horizon Pharmaceuticals (advising on MG and neuromyelitis optica spectrum disorder); Takeda (advising on autoimmune diseases); GLG Consulting, Putnam Consulting, Slingshot Consulting, Haven Consulting, Clearview Consulting, Alpha Sites Consulting, and Insights Consulting (providing insights on the current and future treatments of several neuroimmunologic diseases including MS, MG, Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, and neuromyelitis optica spectrum disorder). RPL has presented several CME talks for companies with multiple sources of support (no direct payments to RPL). RPL has received clinical trial grants (no direct payments) for studies in MG (Alexion, Argenx, Ra Pharmaceuticals) and MS (Novartis, Teva, Genentech/Roche, Chugai). He has received royalties from Blackwell Press as an editor of the textbook International Neurology, and from Oxford University Press as an editor of a book, Neuroimmunology. RPL is an author of several papers cited in this topic.
Agradecimientos
Dr Robert Lisak would like to gratefully acknowledge Dr Andrea Corse and Dr Ami Mankodi, previous contributors to this topic.
Divulgaciones
AC and AM declare that they have no competing interests.
Revisores por pares
Vern C. Juel, MD
Associate Professor of Medicine (Neurology)
Duke University
Durham
NC
Divulgaciones
VCJ declares that he has no competing interests.
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