Outpatient Management

By Sylvia Danehy, RN - Notes from the 2005 MGA Educational Seminar

Medical Assessment - These represent the steps to successful treatment of MG

Symptoms of Myasthenia Gravis

• Ptosis
• Diplopia
• Weakness
• Dysarthria
• Dysphagia
• Dysphonia
• Dyspnea

Diagnosis

• Clinical History
• Acetylcholine Receptor Antibody Titre (Binding, Blocking, Modulating)
• MuSk antibody
• CT Scan of chest
• EMG
• Tensilon test
• Addition blood studies

Treatment Plan

• Medications (Some types include: Mestinon, Prednisone, Imuran, CellCept, Cyclosporine, Cytoxan)
• Thymectomy - Sternal Split / Laproscopic
• Plasmapheresis - Used as a treatment for worsening symptoms, an adjunct to prepare a patient for surgery, and/or as an additional ongoing treatment for MG symptoms not responding to medication alone.
• IVIG - Can be used instead of plasmapheresis and can be home infused

Response to Treatment Plan

• Any change in symptoms
• Any complications

Change to Treatment Plan

• Adjust dosages
• Add any new treatments

Communication

• Without good communication, a proper treatment plan cannot be adequately implemented
• Good communication can prevent problems
• What the patient doesn't say can be as important as what is said

Physician must Communicate to the Patient

• What the diagnosis is
• What can affect symptoms
• What the treatments entail
• What should be reported back to the doctor
• Where they can find information

Diagnosis - Myasthenia Gravis "Grave Muscle Weakness" - A diagnosis of MG can be very frightening because MG is:

• Not common
• The patient's never heard of it
• Doesn't know anyone who has it
• It sounds serious (Gravis/Grave)

What the Patient needs to know about Symptoms

• It is normal for symptoms to fluctuate
• Stress can aggravate symptoms
• Periods of rest may alleviate symptoms
• Infections can worsen symptoms

What the Patient needs to know about Treatments

• Effects and side effects of medications
• Any special testing that is needed to monitor side effects
• Adjustment to dose - HOW and WHEN to make adjustments
• What does a thymectomy entail
• What are plasmapheresis and/or IVIG

What the Patient needs to know about Contacting the Physician

• How often should they return for a visit
• How are questions handled between visits (i.e. Best time to call, who will take calls, when a response can be expected, what about emergencies)

The Physician Needs to be Aware of the Following

• The patient's level of understanding
• The patient's level of compliance
• The patient's willingness to accept his/her diagnosis
• The patient's willingness to admit to increase in symptoms and reporting it promptly
• That early intervention may prevent many problems

The Physician and Patient Must Work Together as a Team by

• Learning to trust each other
• Striving to improve symptoms
• Cooperating to prevent crisis

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