Talk:Myasthenia gravis
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Has there been any research done about this disease and it's relationship to marijuana abuse?
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[edit] Help Requested, Vandalism?
A few months ago this was a beautiful article. When I checked it today I found a stub that had been flagged by a bot. In looking at the history, I noticed the article contained: "Some ways patients found to deal with their symptoms: - Not treating the ptosis is the best way to deal with diplopia: if one eye is covered by the eyelid you're not botherd by double vision! - For some, not speaking during a meal helps "saving up" for chewing and swallowing. - Resting improves the symptoms, but only short term. Fear of long term worsening is not necessary and should not withhold a patient from daily activities. - Special glasses exist with "ptosis hooks" to keep the eyelids open."
Now that doesn't belong here. I traced this all the way back to December 12th, 2006 with Pizzaman's entries. I'm not very good at this, but I tried to revert the page back to its December 8th version which appears to be what I remember. Can everyone please reincorporate any serious changes they may have made in that time? Please restore this article! Freazer 10:40, 14 February 2007 (UTC)
Answer:
Dear Freazer,
I consulted several neurologists, a neurophysiologist, a research group looking for new medicines for MG, a patients association and the original author when improving the article. I suggest we collaborate to make a good article, in stead of reverting to older versions. For most changes i made i had good reasons, so perhaps you can discuss any changes you don't agree with, in stead of undoing all the effort that was put in it. It is very unfortunate that the article became victim to vandalism since february 1st so i suggest we both try to keep it vandalism-free. Perhaps we the wiki group can make editing members-only. Anyway, my changes were not vandalism.
The reason i added section you mentioned: As i see it, this article is intended to give information to people who want information about myasthenia gravis. That will mostly be patients, their friends and relatives and doctors, nurses and researchers. I also added a lot of information useful for doctors and researchers. But to patients thís is very useful info, and imo adding info like this makes the wiki better than any other encyclopedia. Because it actually answers one's questions. Nevertheless i left the section out, since it especially seemed to bother you. Hope to hear from you soon; you can mail me at arendhamming(at)gmail(dt)com.
Pizzaman79 11:31, 9 March 2007 (UTC)
[edit] I doubt this
The article says: Applying ice to the weak muscle groups may characteristically improve the weakness. Is this true?
- Yes, this factlet is specifically supported by the Scherer reference. JFW | T@lk 13:26, 22 December 2005 (UTC)
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- Yes, cooling increases the sensitivity of the postjunctional membrane to acetylcholine and decreases cholinesterase activity. (Nerve conduction speed and acetylcholine release are decreased by cooling and these adversely affects neuromuscular transmission. This, however, is partially counteracted by decreased muscle-ChE activity and increased sensitivity of the postjunctional membrane to ACh caused by cooling. In MG patients these last two effects have a much greater effect than in healthy individuals and neuromuscular transmission actually improves. See also PMID 690633) --WS 14:04, 22 December 2005 (UTC)
[edit] Myasthenia is derived from Greek; Gravis is from Latin
From the top of the page:
Myasthenia gravis (MG, Latin: "grave muscle weakness")
See
http://www.lef.org/protocols/prtcl-080.shtml
Myasthenia: from the Greek words, myelos, meaning muscle, and astheneia, meaning weakness Gravis: from the Latin word, gravidus, meaning heavy (serious) —The preceding unsigned comment was added by 62.25.109.194 (talk • contribs).
- Thank you for your suggestion regarding [[: regarding [[:{{{1}}}]]]]! When you feel an article needs improvement, please feel free to make whatever changes you feel are needed. Wikipedia is a wiki, so anyone can edit almost any article by simply following the Edit this page link at the top. You don't even need to log in! (Although there are some reasons why you might like to…) The Wikipedia community encourages you to be bold. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. --WS 13:09, 11 January 2006 (UTC)
[edit] Re-write of Prognosis section
First, I wish to declare my bias, so you can call me on it if I let it affect my contributions. I have a friend who's been diagnosed with MG and her friends are visiting wikipedia for a quick summary. Unfortunately, the "Prognosis" section gives the impression MG is completely treatable, which is not true. When I went digging I found the origins of the pronosis section:
With treatment, most patients have a near-normal quality of life and no significant problems. Some cases of myasthenia gravis may go into remission temporarily and muscle weakness may disappear completely so that medication can be discontinued. Stable, long-lasting complete remissions are the goal of thymectomy, although this cannot always be achieved. (Wikipedia, current version)
It appears to be based on a factsheet from the US government, aimed at patients:
With treatment, the outlook for most patients with myasthenia gravis is bright: they will have significant improvement of their muscle weakness and they can expect to lead normal or nearly normal lives. Some cases of myasthenia gravis may go into remission temporarily and muscle weakness may disappear completely so that medications can be discontinued. Stable, long-lasting complete remissions are the goal of thymectomy. In a few cases, the severe weakness of myasthenia gravis may cause a crisis (respiratory failure), which requires immediate emergency medical care. (see above). (Fact Sheet).
The fact sheet is careful not to alarm people, but the wikipedia entry omits all negative information. Overall, the wikipedia entry gives a very rosy picture. Now I'm going to try and re-write that section based on other sources.
geoff_o 21:50, 26 October 2006 (UTC)
I think from a doctor's perspective there are many worse, less treatable diseases. Especially from a neurologist's perspective. I agree it should not sound too optimistic. On the other hand i see a lot of patients that googeled their disease and then come to the doctor with their heads full of worst case scenario's. Sometimes to the point where these thoughts bother the patient even more than the disease itself! So it's always difficult to strike a balance. If the update i did on the english version is read and corrected, i'll translate it to Dutch. Then i'll try to get some dutch patients to look at it, i'm already in contact with the dutch foundation for muscle diseases. If i get the opportunity i'll specifically ask them about their experiences. Pizzaman79 13:33, 13 December 2006 (UTC)
[edit] Details
I just did a few months of research with the dutch MG expert, Dr De Baets (MD). This is a great article, but i think it misses some details here and there. I could ask De Baets to help me look into it, but i'm only going to ask him to spend some of his valuable time if the guys from wikipedia are going to lock it afterward. Some examples...
- The autoimmune process is NOT fully clarified imho. First of al some of the patients don't carry AchR or MuSK antibodies. Since they do respond to immunosuppresive therapy they probably have some other, yet unknown, auto-immune process. Also, MG seems different from other autoimmune diseases. Some genetical variations (SNP's) seem to have effects opposite to other auto immune diseases, sometimes ascribed to T-cell maturation in the thymus.
- The stuff about ice is a very neat trivia. But a reader will think this is the common way doctors examine patients and it's not. So that should be clarified. What i miss is an explenation about which tests doctorsactually do. For example, just asking a patient to keep his arms stretched out (Barré style) will clearly show fatiguability of a muscle with otherwise good strength (usually 5/5). I have an book about MG by Oosterhuis, i should look up what he sais in his chapter about the physical exam.
- The part on the blood test could state more clearly that the diagnostical use of the test is limited. The ultimate test is a patient's response to immunosuppressive therapy, in my experience. Also, wasn't the antibody titer useful for followup? (i'd have to look that up)
- Pathophysiology: again too optimistic to my taste. Even when testing for MuSK there are still sero-negative patients and i believe the MuSK test is not something many hospitals offer. Without that you'll have quite a lot of seronegative patients. (i'm not even sure if the AchR test is that common)
- Epidemiology: do we have figures about congenital MG? Also there are two epidemiologic peaks: females in their 30's and males in their 50's and 60's. This suggests perhaps hormonal influence or two distinct entities and should therefor be mentioned.
- I think if you mention thymectomy and chest (thymus) CT's for thymoma imaging, you should also explain the correlation a little more thorough than "There are various theories that explain why thymoma may predispose to MG"
These are just some things that cought my eye in a first quick read. Since i'm suggesting a lot more than a few minor changes i suggest the original author can contact me so we can perhaps collaborate on a rewerite.
Edit: i contacted the original author and another person doing research on the topic. It may take some time, but i'll do a rewrite.
Edit2: I changed the article now. It didn't need as much changing as i first expected. One point of discussion remains: prevalence. I have a neurology book stating it is 40/million, whereas myasthenia.org says 20/100.000 is an underestimation! Who can find an authorative reference?
Pizzaman79 03:31, 11 December 2006 (UTC)
As an MG patient, I would think that myasthenia.org would have more recent info, however, as it is with everything realted to MG, I think a 100% accurate info is not available. Bengisuk 10:53, 9 February 2007 (UTC)
Agreed.
