What is Muscle weakness?
It is defined as a disorder in which there is a problem in the nerves as well as muscles. It can lead to the weakness of muscles as well as fatigue. It is also known as muscle weakness and is due to the use of circulating anti bodies. It is due to the use of acetyl choline receptors which are present at the junction where nerves and muscles are present. It affects the stimulation of neuro transmitter acetyl choline. It is treated medically with the help of inhibitors of immune suppressants. It can also be treated with the help of thymectomy. It must be differentiated from the congenital myasthenic syndromes. They are quite similar to these disorders.
What are the signs and symptoms of Muscle weakness?
It includes the easy fatigue; muscles become weak when there is an activity. They improve a lot when the person rests. There are few muscles which are affected more such as the muscles of eye as well as eyelids, face expression as well as which help in the process of talking, chewing as well as swallowing. There are few muscles which control the breathing along with the neck as well as limb movement. The physical examination is quite helpful. The symptoms are not continuous and the onset is sudden. In this disorder the diagnosis is delayed. The early symptom is the presence of weakness in the muscles of eye. There is a problem in the swallowing as well as in the speech. The weakness of muscles can be localized or can involve the muscles of eye. It can also involve the breathing muscles later on. In later stages it can lead to double vision as well as the drooping of both eyelids. It can lead to weakness in the arms, fingers as well as legs and neck. There is a problem in the swallowing as well as shortness in breath followed by the impairment in speech. In case of crisis there is a paralysis of the muscles of respiration. One needs a ventilation help so that the life can be sustained. The condition gets worse if there is an infection, fever as well as stress. There can be an adverse reaction to medicines also. The autonomic nervous system regulates the muscles of heart.
How Muscle weakness can be diagnosed?
It includes the use of visual examination and a patient history. It is quite difficult to diagnose. One can go for the neuro physiology also. The symptoms are difficult to recognize. The fatigue can be known by the help of physical examination. One can use ice in the case of weak muscles. It improves their function. In few cases medicines are also helpful and are considered to be of auto immune disorder. The physical examination includes the use of eyes which help to look upward as well as side wards. One must look at the feet when the person lies for a minute. The arms must be stretched for a minute and one must walk few steps on both the heels as well as toes. One can go for quick sit ups. There is a special test known as the peek sign in which there is a separation of the lid margins and one can see the sclera. One can also go for the blood tests which help us to know about the infection. It also helps to know about the presence of anti bodies. There are anti bodies which are present in the one form or other. In few situations like the presence of cancer in lung one can go for the test of other antibodies. The fibers of muscles get tired very easily and they do not repond to stimulation. The fatigue ability of muscles can be measured with the help of electrical impulses. It is known as repetitive nerve stimulation test. The most sensitive single fibre is diagnosed with the help of electro myo graphy. In this case a single electrode is put into the muscle so that the electric potentials can be recorded. The two different muscle fibres belong to the similar motor unit also helps to know about the diagnosis. The other test which is helpful is known as the edro phonium test. It is not done regularly and is done in cases where there are other investigations are not feasible. It uses a complex product known as the edrophonium chloride. It has the ability to stop the breakdown of acetyl choline with the help of choline esterase. It increases the level of acetyl choline for some time. It is quite helpful in the cases where eyes are involved.
Imaging in the form of chest x rays is quite helpful. It may complicate the diagnosis. But it may also tell about the increase in mediastinum and it tells about the thymoma. One can also go for computed tomography and magnetic resonance imaging. Spirometry which is a pulmonary function test is quite helpful to know about the functions of lung. It tells about the breathing ability of patient. The vital capacity which is forced one helps to know about the weakness of muscles. The adequacy of ventilation tells about the negative inspiratory force which is referred as the NIF. In severe cases respiratory failure may also occur as there is a paralysis of the respiratory muscles. One can go for the biopsy of muscles which must be done at last. IgG antibodies can be recognized at the neuro muscular junction. It is done mainly with the help of immune fluorescence. The electron microscope is also quite helpful.
How Muscle weakness can be treated?
It includes that there is no specific treatment for this disorder. One must identify the cause for it and must act against it. The two possible treatments are medicine as well as surgery. It is done with the help of inhibitors of immune suppressants. It can also be treated with the help of thymectomy. In case of emergency one can go for the plasma pheresis which helps to remove the antibodies from the circulation of blood. The medicines which we use are the acetyl choline esterase inhibitors. They prevent the activity of the acetyl choline. They improve the activity of muscle by decreasing the function of natural enzyme. It includes the cholinesterase which breaks the acetyl choline in the motor end of plate. The neuro transmitter can stimulate the receptor. The dose is small and is increased initially. It may lead to diarrhea. One can also go for few immune suppressive drugs such as prednisone and cyclo sporine. The patient must be treated with the help of combination of all drugs. It takes few weeks to months so that the effects can be known. In serious circumstances one can go for the plasma pheresis as well as intra venous immune globulins and are referred as the IVIG. Their benefits are short lived.
In case of surgery one must remove the thymus and is known as thymectomy. It is done in the cases of thymoma in which there are cancerous cells. It is not effective in the case of patients with problems in thymoma. In the case of increase in size of thymoma one can go for the therauptic thymectomy. The thymus gland can be removed with the number of causes such as through the neck, sternum or chest. The sternum approach is most important. The approach through neck is not much successful. The tissue which is removed with the thymoma has the ability to grow. They can lead to cancer formation if they are not removed. One must always prefer a sternum approach. Thymoma is quite common in the age group above 40 years. One can also go for resection.
How Muscle weakness can be prevented?
It includes the avoidance of any irritating factor. One must avoid alcohol, tobacco and cigarette smoking.
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