When a patient has myasthenia gravis, abnormalities of the thymus gland cause the immune system to attack against healthy neurotransmitter substances and prevent them from helping muscles contract. It is an autoimmune disorder in which antibodies destroy neuromuscular connections. Normally, an impulse goes through the nerve and the nerve ending releases acetylcholine, which then binds to a receptor and causes a muscle contraction. In those with myasthenia gravis, the acetylcholine receptors are destroyed or blocked by the attacking antibodies, preventing the muscle contraction from taking place.
This leads to debilitating muscle weakness, fatigue, difficulty swallowing, blurred or double vision and impaired speech. As the muscles that control these actions continually weaken, symptoms worsen. It affects the voluntary muscles of the body, particularly in the throat, mouth, eyes and limbs. The muscle weakness caused by myasthenia gravis is typically more pronounced after periods of activity and less evident after periods of rest.
Myasthenia gravis most commonly strikes women under the age of 40 and men over the age of 60, but can occur at any age. A medical history and thorough physical and neurological exams are helpful in making a diagnosis. Blood tests, an edrophonium test and nerve conduction studies, often performed in conjunction with electromyography, helps to confirm the diagnosis of myasthenia gravis.
Medication is usually effective in treating this condition and increasing muscle strength and is often the first line of defense. However, it can cause side effects such as weight gain and a weakened immune system in some patients.
Surgical treatment of myasthenia gravis, called a thymectomy, involves removing the entire thymus gland. The thymus typically shrinks as we age, but when myasthenia gravis is present, it remains large and contains abnormal immune cells. Many patients are cured after surgery, as the immune system can be re-balanced to no longer attack itself.
Neuropathic pain is a chronic condition caused by damage, dysfunction or injury within the actual nerve fibers, which results in the delivery of incorrect signals to pain centers within the body. This may occur as a result of several different factors, including surgery, chemotherapy or amputation, or conditions such as diabetes, HIV, multiple sclerosis and others.
Patients with neuropathic pain may experience shooting pain, numbness, tingling and weakness in certain areas of the body.
Treatment for neuropathic pain may include anti-inflammatory medication, electrical stimulation or implantable devices. More effective management of underlying conditions, such as diabetes, can also help relieve pain. This condition tends to get worse over time rather than better, so finding a successful treatment method is important.
Trigeminal neuralgia, also known as tic douloureux, is a chronic condition that causes severe, shooting pain in the face as a result of a blood vessel pressing on the trigeminal nerve as it exits the brain. This pain usually comes on suddenly and can last from a few seconds to a few minutes, but may be physically and mentally incapacitating. Most patients experience pain on one side of the jaw or cheek.
It may also be related to multiple sclerosis or other neurological conditions that damage the myelin sheath that protects nerves. Although less common, trigeminal neuralgia may also be caused by a tumor on the trigeminal nerve.
Episodes may be triggered by certain activities that cause a vibration or contact with the cheek, such as shaving, brushing your teeth or applying makeup, as well as eating, drinking or talking. As the condition progresses, episodes of pain may become longer and more frequent.
Since this condition can be caused by several factors, diagnosing trigeminal neuralgia is often difficult. Determining the cause of the pain is crucial in determining the best course of treatment for each individual patient. Treatment for trigeminal neuralgia may include medications such as anticonvulsants and antidepressants, or surgery for more severe or refractory cases.
Trigger point injections are a treatment option for pain in areas that contain trigger points, or knots of muscle that form when muscles do not relax. These points can also irritate nerves around them and therefore cause pain in other areas of the body. A needle containing a local anesthetic (and sometimes a steroid as well) is inserted into the trigger point to make it inactive and therefore alleviate the pain.
The procedure takes just a few minutes and is done in the doctor's office. It is very safe and has minimal side effects. Trigger point injections not only relieve pain, but also loosen the muscles which are causing the pain to therefore help with the rehabilitation process.