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Ansley Barfield
Writing Assignment 2
Funbi Awoniyi Wed lab
3/21/2012
Myasthenia gravis is a disease brought on by the immune system destroying
acetylcholine receptors on the postsynaptic membranes of the skeletal muscle cells. If not
diagnosed and treated, the acetylcholine will disappear all together. This ultimately leads
to muscular weakness, which is a major symptom and concern in Susans case. She
claims in the neurology appointment with Dr. Fitz that she is feeling more fatigued and
has been having trouble keeping up with her regular workouts, as she gets easily
exhausted. For example, she mentions that she can no longer lift weights, which
indicates that her muscles have grown weaker. Another symptom of myasthenia gravis
besides muscular fatigue, is vision impairment (Kaminski ). She mentioned to the doctor
that her sight has recently worsened and that she cannot even keep her eyes open.
Furthermore, she goes on to mention that she sometimes sees double and falls. Her
voluntary muscles seem to be greatly affected, as she said she couldnt control her saliva
or mouth muscles and began drooling. She also had slurred speech, which indicates that
there is definitely an issue with her skeletal muscles. In the other disease, myotonic
muscular dystrophy, chlorine ions have difficulty moving in and out of muscle cells.
These charged chlorine ions are essential for proper electrical control of muscle
contractions and relaxation (Kaminski). Susan symptoms are in accordance with this, as
she cannot control any aspect of her muscles, whether shes exercising or trying to relax.
She said that her muscles often feel very tense and that she is having a difficult time
relaxing, signifying that there is an issue with her muscles and her ability to control them
neurologically. Although, myotonic muscular dystrophy is known to cause pain in the
joints, but Susan has not experienced any at this point.
To diagnose which disease Susan has, she will have to complete a neurological
and muscular exam, the EMG. The electromyography will record the electrical activity
being produced by Susans skeletal muscles, specifically the muscles. The machine used
for EMG assessments will detect the electrical potential produced by her muscular cells
when the cells are electrically stimulated with myotonia. Normal results of an EMG
show that with a voluntary increase of muscle contractions, an increase number of muscle
fibers produce action potentials. When the assessment is done, the results should show a
series of action potentials in a smooth, wavy line, showing differing rates & amplitudes
when the muscle was not at rest. If the muscle was at rest, then no electrical activity
should occur (Lichardus 86). An abnormal EMG can generally indicate that there could
be a problem with the nerve supply to the muscles if that patient shows electrical activity
while the muscles are at rest.
Prostigmin is a prescription medication that interferes with the breakdown of
acetylcholine, so that muscle contraction can occur before it paralyzes. If taken before an
EMG, it will most likely skew the results of the test. This medication (Prostigmin)
causes muscle weakness to greatly improve for a very short period of time, which could
give a false read to the doctor on how ones muscular cells are responding to the action
potentials(Lichardus 90). Although, if Susan is diagnosed with myasthenia gravis,
Prostigmin is generally prescribed for treatment, as it helps with neuromuscular diseases.
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There are various physiological reasons that Susans EMG sounded like a
revving engine. First, Susan has trouble with muscle control and relaxation, so the sound
heard will not be consistent. The inconsistency she has in the audio activity of her EMG
shows that her muscles are not responding to electrical signals when they should be.
Susan cannot control when she has a contraction, as her skeletal muscles are now almost
completely involuntary & unpredictable. The sound would intensify with administration
of Prostigmin because the prescription gives a person immediate satisfaction, in terms of
their muscular fatigue. It briefly allows a person to have immediate control of their
muscles due to the medicines ability to trick the body into not destroying the
acetylcholine. This quick boost would intensify the sounds of the EMG, but it would not
be inconsistent. The voluntary contractions performed by the patient after the electrical
signal would be stronger, therefore, much louder.
Susan is suffering from myasthenias gravis. She shows all the classic symptoms
of the disease, such as the muscle fatigue, slurred speech, and vision problems.
Neurological control over ones muscles is crucial, as they make up the majority of the
bodys composition. In the EMG, it became apparent that Susan had a serious
neuromuscular problem when her results were abnormal with the extreme inconsistent
electrical activity in the muscular tissue. Susan lost complete control over her body when
she couldnt control her facial muscles, arm muscles, leg muscles, or even the muscles
surrounding her eyes. Droopy eyelids, double vision, muscle stiffness and fatigue, as
well as slurred speech are all supporting the conclusion that she does have myasthenias
gravis.
























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Works Cited

Lichardus, Branislav, and Guder Walter. EMG. Prague: Avicenum, 86-90. eBook.

Kaminski, Henry. Myasthenia Gravis and Related Disorders. illustrated. John Wiley &
Sons, 2004. 36-40. eBook.
http://books.google.com/books?id=DampyXkudq8C&dq=myasthenia+gravis&source=gb
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