<<forEachTiddler  where 'tiddler.tags.contains(context.inTiddler.title)'
sortBy 
        tiddler.title
    ascending 
write '"*[["+tiddler.title+"]]\n"'>>
<<tiddler AutoRefresh with: force>>

autoimmune disorder resulting in insufficient functioning acetylcholine receptors
Antibodies to acetylcholine receptors are seen in 85-90% of cases (less commonly seen in disease limited to ocular muscles)
2:1 women:men

//muscle fatigability// - muscles become progressively weaker during periods of activity and slowly improve after periods of rest:
    extraocular muscle weakness: diplopia
    proximal muscle weakness: face, neck, limb girdle
    ptosis
    dysphagia

''Associations''
    thymomas in 15%
    autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE
    thymic hyperplasia in 50-70%

''Investigations''
    single fibre electromyography: high sensitivity (92-100%)
    CT thorax to exclude thymoma
    CK normal
    autoantibodies: around 85-90% of patients have antibodies to acetylcholine receptors. In the remaining patients, about about 40% are positive for anti-muscle-specific tyrosine kinase antibodies
    Tensilon test: IV edrophonium reduces muscle weakness temporarily - not commonly used anymore due to the risk of cardiac arrhythmia

''Management''
    long-acting anticholinesterase e.g. pyridostigmine
    immunosuppression: prednisolone initially
    thymectomy

''Management of myasthenic crisis''
    plasmapheresis
    intravenous immunoglobulins