Miastenia gravis

Última revisão: 28 Ago 2022
Última atualização: 30 Ago 2022

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • fatigabilidade da força muscular
  • ptose
  • diplopia
  • disfagia
  • disartria
  • paresia facial
  • fraqueza muscular proximal
  • dispneia
Mais principais fatores diagnósticos

Fatores de risco

  • história familiar de distúrbios autoimunes
  • marcadores genéticos
  • terapia dirigida ao câncer
Mais fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • análise de anticorpo sérico antirreceptor da acetilcolina (AchR)
  • anticorpos antitirosina quinase músculo-específica (MuSK)
  • testes seriados de função pulmonar
Mais primeiras investigações a serem solicitadas

Investigações a serem consideradas

  • testes de anticorpos antirreceptor de músculo estriado
  • estimulação nervosa repetitiva
  • eletromiografia (EMG) de fibra única
  • tomografia computadorizada (TC) do tórax
Mais investigações a serem consideradas

Algoritmo de tratamento

Aguda

crise miastênica

Contínua

doença leve a moderada (classe I a III)

doença grave (classe IV ou V) ou refratária

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

Declarações

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.

Agradecimentos

Dr Robert Lisak would like to gratefully acknowledge Dr Andrea Corse and Dr Ami Mankodi, previous contributors to this topic.

Declarações

AC and AM declare that they have no competing interests.

Revisores

Vern C. Juel, MD

Associate Professor of Medicine (Neurology)

Duke University

Durham

NC

Declarações

VCJ declares that he has no competing interests.

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