Neuromuscular Junction and Myasthenia Gravis

by Carlo Raj, MD

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    Once again, I’ll bring this illustration to your attention because I want you to know where we are and what we’re dealing with. So, we’re doing neuromuscular diseases, and we spent an awful lot of time with peripheral neuropathy and such. And we talked about diseases of the anterior horn, motor neuron diseases such as amyotrophic lateral sclerosis. With peripheral neuropathy, we went through plexopathies, we went through mononeuropathy, mononeuritis multiplex, and walked through polyneuropathies. And then what we have left now is going to be neuromuscular junction diseases, and then we’ll have our myopathies including our, what’s known as your muscular dystrophies, Duchenne and company. At this junction, pun intended, it was the neuromuscular junction. Let’s begin. With neuromuscular junction, well, what are we looking at? What if the problem was presynaptically? And that’s where the disease was. So, think about where you are first. Neuromuscular junction. You’re going to release what at the neuromuscular junction? Acetylcholine. What does it bind to? Your acetylcholine receptors, a.k.a., nicotinic receptors. These are ligand-gated. This then opens up your sodium channel, and in comes the sodium, right? But in order for you to release that acetylcholine, what do you need to bring in presynaptically so you can release it? Ah! Voltage-gated calcium channel. So, presynaptic disease, Lambert-Eaton myasthenic syndrome. We have already talked about this as being possibly paraneoplastic with small cell lung cancer. Botulism, what does that do? Well, if you’re injecting botulinum, right? Why? Because you heard Botox, right? That’s amazing to me. But you’re trying to iron out the wrinkles by inhibiting the release of acetylcholine presynaptically. And something called tick paralysis, presynaptic. Postsynaptically, the infamous myasthenia gravis. That’s where we’ll begin is myasthenia gravis. Clinical features: What happens here? Well, most likely, an autoimmune disease automatically puts you...

    About the Lecture

    The lecture Neuromuscular Junction and Myasthenia Gravis by Carlo Raj, MD is from the course Polyneuropathy. It contains the following chapters:

    • Neuromuscular Junction
    • Myasthenia Gravis

    Included Quiz Questions

    1. Myasthenia gravis
    2. Lambert-Eaton Myasthenic Syndrome
    3. Botulinum toxin
    4. Tick paralysis
    5. Autoimmune neuromyotonia
    1. Pupils
    2. Eyelids
    3. Lateral rectus
    4. Medial rectus
    5. Levator palpebrae superioris
    1. Postsynaptic acetylcholine receptors
    2. Presynaptic vesicles
    3. Acetylcholine esterase
    4. Acetylcholine release
    5. Mitochondria of the axon
    1. Thymic shadow
    2. Fundic gas shadow
    3. Heart shadows
    4. Lung hamartoma shadows
    5. Pleural effusion shadows
    1. Acetylcholine
    2. Methotrexate
    3. Plasmapheresis
    4. Acetylcholine esterase inhibitors
    5. Thymectomy

    Author of lecture Neuromuscular Junction and Myasthenia Gravis

     Carlo Raj, MD

    Carlo Raj, MD

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