Muscle Fatigability Research Articles

A Phase 3, Open-Label, Multicenter Study To Evaluate Eculizumab In Adolescents With Refractory Generalized Myasthenia Gravis (S5.009)

A Phase 3, Open-Label, Multicenter Study To Evaluate Eculizumab In Adolescents With Refractory Generalized Myasthenia Gravis (S5.009)

The clinical and genetic characteristics of 17 cases with Congenital Myasthenic Syndrome: Data from a single center (P2-8.002)

<h3>Objective:</h3> The aim of this study to investigate the clinical and genetic features of patients with Congenital Myasthenic Syndrome (CMS) in Muscle Disease Center, Koç University Hospital, Turkey. <h3>Background:</h3> CMS is a group of hereditary disorders of impaired neuromuscular transmission characterized by fatigable muscle weakness. <h3>Design/Methods:</h3> Herein, we present the characteristics of 17 patients from 14 unrelated families. <h3>Results:</h3> The mean age (3 male, 14 female) was 18.4+13.6, the onset age ranged between the first day and the first 3 months of life in 11 cases, and 1 and 16 years in 6 patients. The most common complaints at the first 3 months were ptosis (6/11), feeding difficulty (7/11), difficulty in breathing (3/11). After the first age of life, walking late (2/6) and fatigue triggered by movement (6/6) were common. <i>CHRNE</i> (homozygous [c.1219+2T&gt;G]; [c.199 G&gt;T]; and novel [c.452_454delAGG]; heterozygous [c.1220-8+8dup and c.1327–1327delG]; [ c. .1327delG and c803-2A&lt;G]) (5 patients): All showed mildly weakness in ocular, bulbar and limbs muscles and good response to pyridostigmine. <i>DOK7</i> (homozygous [c.93_95delCTGLP+c.1120_1121insGCCTP]) (3 siblings). Mild ocular and bulbar muscle weakness, moderate limbs weakness were found and benefiting from salbutamol. <i>GFPT1</i> (composite heterozygous [c.50G&gt;A and c.408+5G&gt;A]; homozygous [c.686-2A&gt;G]; [c.44C&gt;T, p.]) (3 patients) and <i>CHAT</i> ([c.1669G&gt;A]) (1 patient): All were ambulatory and had good response to pyridostigmine. <i>COLQ</i> (homozygous [14–15 exons] deletion and c.44G&gt;A,) (3 patients ): Two siblings worsened under pyridostigmine, and had a marked response to salbutamol. The other one benefited from 3,4-diaminopyridine. <i>AchR</i> epsilon subunit (combined heterozygous [L240I and C302Y]) (1 patient): , She showed respiratory distress and markedly response to pyridostigmine. <i>AGRN</i> (novel,homozygous [c.5387G&gt;A and C4217 A&gt;C]) (1 Patient). She had fatigue and worsened with pyridostigmine and had a dramatic response from salbutamol. <h3>Conclusions:</h3> In our study, similar to many studies, the most common findings were ocular and bulbar symptoms, and the most common genetic disorder was postsynaptic (65%) conduction defects. <b>Disclosure:</b> Dr. Yunisova has nothing to disclose. Dr. ARDUC AKCAY has nothing to disclose. Dr. Avci has nothing to disclose. The institution of Dr. Eraslan has received research support from THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY. Prof. Kayserili has received research support from TUBITAK . Prof. Kayserili has received personal compensation in the range of $500-$4,999 for serving as a Projecct PI, advisor, researccher with TUBITAK . Prof. University has nothing to disclose.

Myasthenia Gravis Activities of Daily Living (MG-ADL) Response to Eculizumab Treatment in Patients from the Generalized Myasthenia Gravis Registry (P1-5.020)

Myasthenia Gravis Activities of Daily Living (MG-ADL) Response to Eculizumab Treatment in Patients from the Generalized Myasthenia Gravis Registry (P1-5.020)

Impaired Physical Performance in X-linked Hypophosphatemia Is not Caused by Depleted Muscular Phosphate Stores.

X-linked hypophosphatemia (XLH) is a rare genetic disease, characterized by renal phosphate wasting and complex musculoskeletal manifestations including decreased physical performance. To characterize muscular deficits in patients with XLH and investigate phosphate stores in muscles. Case-control study (Muscle fatigability in X-linked Hypophosphatemia [MuXLiH]) with a 1-time assessment at the German Aerospace Center (DLR), Cologne, from May to December 2019, including patients with XLH cared for at the Osteology Department, University of Wuerzburg. Thirteen patients with XLH and 13 age/sex/body weight-matched controls aged 18-65 years were included. The main outcome measure was 31P-magnetic resonance spectroscopy (31P-MRS)-based assessment of phosphate metabolites in the soleus muscle at rest. Further analyses included magnetic resonance imaging-based muscle volume measurement, laboratory testing, isokinetic maximum voluntary contraction (MVC), fatigue testing, and jumping mechanography. By means of 31P-MRS, no significant differences were observed between XLH and controls regarding phosphate metabolites except for a slightly increased phosphocreatine to inorganic phosphate (PCr/Pi) ratio (XLH: 13.44 ± 3.22, control: 11.01 ± 2.62, P = .023). Quadriceps muscle volume was reduced in XLH (XLH: 812.1 ± 309.0 mL, control: 1391.1 ± 306.2 mv, P < .001). No significant differences were observed regarding isokinetic maximum torque (MVC) adjusted to quadriceps muscle volume. Jumping peak power and jump height were significantly reduced in XLH vs controls (both P < .001). The content of phosphoric compounds within the musculature of patients with XLH was not observed to be different from controls. Volume-adjusted muscle strength and fatiguability were not different either. Reduced physical performance in patients with XLH may result from long-term adaptation to reduced physical activity due to skeletal impairment.

The relationship between perceived and performance fatigability in severe fibrotic interstitial lung disease: a prospective, cross-sectional study.

This study suggests that interventions geared to improve peripheral factors of performance fatigability during exercise in interstitial lung disease may prove valuable to decrease patients' perceived fatigability, since both seem closely related https://bit.ly/3lpIUPs.

Myasthenia gravis with achalasia secondary to thymoma: a case report and literature review

BackgroundMyasthenia gravis is an autoimmune neuromuscular junction disorder characterized by fatigable muscle weakness and autoantibodies. Frequent associations exist between myasthenia gravis and thymic abnormalities, including hyperplasia and thymoma. Several autoimmune illnesses have been identified to be associated with thymoma; however, a few case reports have linked thymoma and achalasia, and the underlying mechanism is unknown.Case reportA 43-year-old man with thymoma-associated myasthenia gravis presented with dysphagia that was refractory to conventional treatment of myasthenia gravis. This dysphagia was challenging to diagnose even after multiple gastroenterology consults and upper endoscopy. The diagnosis of achalasia type II was established after a comprehensive evaluation, including upper endoscopy, barium swallow, and high-resolution esophageal manometry. The patient underwent elective pneumatic balloon dilatation, which successfully alleviated his dysphagia.ConclusionThis case confirmed the association between myasthenia gravis secondary to thymoma and achalasia and showed how the diagnosis of achalasia was challenging. Awareness of this association is crucial for early diagnosis and treatment, improving affected patients’ quality of life.

Validity and reliability of Eforto®, a system to (self-)monitor grip strength and muscle fatigability in older persons

IntroductionWe developed Eforto®, an innovative system for (self-)monitoring of grip strength (GS) and muscle fatigability (Fatigue Resistance (FR = time until GS decreased to 50% of maximum during sustained contraction) and grip work (GW = area under the strength-time curve)). The Eforto® system consists of a rubber bulb that is wirelessly connected to a smartphone-based application, and a telemonitoring platform. The aim was to evaluate the validity and reliability of Eforto® to measure muscle fatigability.MethodsCommunity-dwelling older persons (n = 61), geriatric inpatients (n = 26) and hip fracture patients (n = 25) were evaluated for GS and muscle fatigability. In community dwellers fatigability was tested twice in the clinic (once with Eforto®, once with Martin Vigorimeter (MV), standard analog handgrip system) and for six consecutive days as a self-assessment at home with Eforto®. In hospitalized participants, fatigability was tested twice using Eforto®, once by a researcher and once by a health professional.ResultsCriterion validity was supported by good to excellent correlations between Eforto® and MV for GS (r = 0.95) and muscle fatigability (FR r = 0.81 and GW r = 0.73), and no significant differences in measurements between both systems. Inter-rater and intra-rater reliability for GW were moderate to excellent (intra-class correlation: 0.59–0.94). The standard error of measurement for GW was small for geriatric inpatients and hip fracture patients (224.5 and 386.5 kPa*s) and higher for community-dwellers (661.5 kPa*s).Discussion/conclusionWe established the criterion validity and reliability of Eforto® in older community-dwelling persons and hospitalized patients, supporting the implementation of Eforto® for (self-)monitoring of muscle fatigability.

Sex differences in quadriceps and inspiratory muscle fatigability following high-intensity cycling.

As females have been hypothesized to have more fatigue resistant inspiratory muscles, this study aimed to compare the development of inspiratory and leg muscle fatigue between males and females following high-intensity cycling. Cross-sectional comparison. 17 healthy young males (27 ± 6 years, V̇O2peak 55 ± 10 ml･min-1･kg-1) and females (25 ± 4 years, V̇O2peak 45 ± 7 ml･min-1･kg-1) cycled until exhaustion at 90% of the peak power output achieved during an incremental test. Changes in quadriceps and inspiratory muscle function were assessed via maximal voluntary contractions (MVC) and assessments of contractility via electrical stimulation of the femoral nerve and cervical magnetic stimulation of the phrenic nerves. Time to exhaustion was similar between sexes (p = 0.270, 95% CI -2.4 - 0.7 min). MVC of the quadriceps was lower after cycling for males (83.9 ± 11.5% vs. 94.0 ± 12.0% of baseline for females, p = 0.018). Reductions in twitch forces were not different between sexes for the quadriceps (p = 0.314, 95% CI -5.5 - 16.6 percent-points) or inspiratory muscles (p = 0.312, 95% CI -4.0 - 2.3 percent-points). Changes in inspiratory muscle twitches were unrelated to the different measures of quadriceps fatigue. Females incur similar peripheral fatigue in the quadriceps and inspiratory muscles compared with men following high-intensity cycling, despite smaller reduction in voluntary force. This small difference alone does not seem sufficient to warrant different training strategies to be recommended for women.

The diagnostic and prognostic utility of repetitive nerve stimulation in patients with myasthenia gravis

Repetitive nerve stimulation (RNS) is a standard test for the diagnosis of myasthenia gravis (MG), where decrement of compound muscle action potentials (CMAP) corresponds to clinical muscle fatigability. Our aim was to ascertain the diagnostic and prognostic utility of RNS in MG patients. This study included MG patients treated between 01/2000 and 12/2016, with an observational period of at least one year and a minimum of two neurological examinations. Clinical and electrophysiological data were retrospectively gathered from patient records, and CMAP decrement was correlated with autoantibody titers and clinical disease severity at different time points. Ninety-four patients were included, with 88.3% of the cohort testing positive for acetylcholine receptor autoantibodies (AChR-Abs). RNS sensitivity was higher in patients with generalized disease (71.6%) than in purely ocular MG (38.5%). CMAP decrement did not significantly correlate with AChR-Ab titers, nor with clinical symptom severity at the time of testing or last follow up. However, there was a significant correlation between CMAP decrement and the worst recorded clinical status on a group level. RNS testing is more sensitive in generalized disease and AChR-Ab positive patients, but our data do not support RNS as a tool for long-term outcome prediction. Future studies with a prospective study design could help to overcome a number of limiting factors discussed in our study.

Myasthenia gravis in current status: epidemiology, types, etiology, pathophysiology, symptoms, diagnostic tests, prevention, treatment, and complications - correspondence.

Myasthenia gravis in current status: epidemiology, types, etiology, pathophysiology, symptoms, diagnostic tests, prevention, treatment, and complications - correspondence.

Effect of muscle fatigue of the thoracic erector spinae on neuromuscular control when performing the upper extremity functional tasks in people with adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) disrupts spinal alignment and increases the intrinsic demand for active stabilization to maintain postural stability. Understanding the paraspinal muscle fatigability and its effects on spinal alignment and kinematics informs the importance of paraspinal muscle endurance for postural stability. This study aims to investigate the effects of fatigue of thoracic erector spinae on the spinal muscle activity and spinal kinematics in individuals with scoliosis. Spinal muscle activity, posture and mobility measured by electromyography and surface tomography were compared between 15 participants with scoliosis and 15 age- and gender-matched healthy controls during unilateral shoulder flexion and abduction with and without holding a 2-kg weight and performed before and after a fatigue task (prone isometric chest raise). No between-groups difference was found for the spinal extensor endurance. Erector spinae activity at the convex side of AIS group was significantly higher than that at their concave side and than that of healthy controls during shoulder elevations, regardless of the fatigue status. Significant decreases in translational and rotational mobility were found at convex side of AIS group during weighted abduction tasks after fatigue. In contrast, a significant increase in rotational mobility was demonstrated at convex side of AIS participants during weighted flexion tasks after fatigue. Our results revealed a comparable level of spinal extensor endurance between individuals with or without AIS. The increase in muscle activation post-fatigue provides no additional active postural stability but may increase the risk of back pain over the convex side in individuals with scoliosis. Findings highlight imbalances in muscles and the potential implications in optimising neuromuscular activation and endurance capacity in the rehabilitation for AIS patients. Future research is needed to investigate if endurance training of the convex-sided back extensors could optimize the impaired neuromuscular control in the AIS patients.

Ryanodine receptor 1 related myasthenia like myopathy responsive to pyridostigmine

Disease causing variants in the Ryanodine receptor 1 (RYR1) gene are a common cause for congenital myopathy and for malignant hyperthermia susceptibility. We report a 17 year old boy with congenital muscle weakness progressing to a myasthenia like myopathy with muscle weakness, fatigability, ptosis, and ophthalmoplegia. Muscle biopsy showed predominance and atrophy of type 1 fibers. Whole-exome trio sequencing revealed three variants in the RYR1-gene in the patient: c.6721C > T,p.(Arg2241*) and c.2122G > A,p.(Asp708Asn) in cis position, and the c.325C > T,p.(Arg109Trp) variant in trans. Treatment with pyridostigmine improved symptoms. This case supports that a myasthenia like phenotype is part of the phenotypic spectrum of RYR1 related disorders, and that treatment with pyridostigmine can be beneficial for patients with this phenotype.

Povezanost mijastenije gravis i imunski-posredovanih miopatija

Introduction/Aim: Myasthenia gravis (MG) is a chronic autoimmune disease of the neuromuscular junction, characterized by muscle weakness and fatigability. Idiopathic inflammatory myopathies (IIM) are an immune-mediated group of diseases characterized by progressive painful proximal weakness of the extremities. The coexistence of these two diseases is extremely rare and so far, only about fifty cases have been reported worldwide. The aim of this study was to analyze the frequency of coexistence of IIM and patients with de novo MG. Material and Methods: The study is retrospective in nature and was conducted at the "Neurology Clinic", University Clinical Center of Serbia. It included 97 patients diagnosed with myasthenia gravis between January 1, 2014 and December 31, 2018. Results: The average age of the MG patients was 54.1±18.9 years. At the time of diagnosis, 19 (19.6%) participants had at least one of the anamnestic data observed as potential indicators for the existence of immune-mediated myopathy. Finally, one patient clinically presented with generalized seropositive (anti-AchR positive) myasthenia gravis associated with the diagnosis of antisynthetase syndrome. In addition, the main characteristics of patients with combined occurrence of de novo MG and antisynthetase syndrome are presented. Conclusion: Although the simultaneous occurrence of MG and IIM is a very rare phenomenon, we need to think about the possibility of combined occurrence of these two autoimmune diseases, with the aim of early recognition and adequate treatment, and thus a better prognosis of both diseases.

Short-term outcome prediction for myasthenia gravis: an explainable machine learning model.

Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatigability. The fluctuating nature of the disease course impedes the clinical management. The purpose of the study was to establish and validate a machine learning (ML)-based model for predicting the short-term clinical outcome in MG patients with different antibody types. We studied 890 MG patients who had regular follow-ups at 11 tertiary centers in China from 1 January 2015 to 31 July 2021 (653 patients for derivation and 237 for validation). The short-term outcome was the modified post-intervention status (PIS) at a 6-month visit. A two-step variable screening was used to determine the factors for model construction and 14 ML algorithms were used for model optimisation. The derivation cohort included 653 patients from Huashan hospital [age 44.24 (17.22) years, female 57.6%, generalized MG 73.5%], and the validation cohort included 237 patients from 10 independent centers [age 44.24 (17.22) years, female 55.0%, generalized MG 81.2%]. The ML model identified patients who were improved with an area under the receiver operating characteristic curve (AUC) of 0.91 [0.89-0.93], 'Unchanged' 0.89 [0.87-0.91], and 'Worse' 0.89 [0.85-0.92] in the derivation cohort, whereas identified patients who were improved with an AUC of 0.84 [0.79-0.89], 'Unchanged' 0.74 [0.67-0.82], and 'Worse' 0.79 [0.70-0.88] in the validation cohort. Both datasets presented a good calibration ability by fitting the expectation slopes. The model is finally explained by 25 simple predictors and transferred to a feasible web tool for an initial assessment. The explainable, ML-based predictive model can aid in forecasting the short-term outcome for MG with good accuracy in clinical practice.

Severity and antibodies profile of seropositive myasthenia gravis

Background: Myasthenia gravis (MG), an autoimmune disease, affects the neuromuscular junction. The impaired neuromuscular transmission results in fatigable muscle weakness among MG patients. Positive antibodies are found among MG patients. Aims: The main aim of this study is to evaluate the correlation of MG severity with their anti-muscle-specific kinase (MUSK) and anti-acetylcholine receptor (AChR) antibody status. Moreover, the study also identifies the correlation between the antibodies profile and the severity of a seropositive MG. Setting and Design: This retrospective cross-sectional study was conducted in the tertiary center of the western region of Saudi Arabia named King Abdullah Medical City (Makkah) over 8 years, from January 2011 to December 2019. Materials and Methods: This retrospective cross-sectional study was conducted in Saudi Arabia in King Abdullah Medical City (Makkah) over 8 years, from January 2011 to December 2019 was reviewed. Seventeen patients out of 27 MG patients came out to be seropositive. The correlation was investigated between severity and antibody status. Statistical Analysis: Data were collected in an Excel sheet, and statistical analysis was performed using SPSS 21 software. Results: The results showed that most patients (87.5%) were positive for AChR antibodies only, while others (12.5%) were positive for anti-MUSK and anti-AChR. Thymoma and crisis were observed in 100% with dual seropositivity and 21% with single seropositivity. Conclusion: The study concluded that a severely aggressive course of MG is present among patients. However, detailed clinical trial studies are required for conforming MG severity and dual seropositivity.

Myasthenia Gravis: Types, Diagnosis and Treatment

The classic autoimmune disease, myasthenia gravis (MG), is brought on by certain autoantibodies at the neuromuscular junction. A classic illustration of an antibody-mediated autoimmune illness is MG. Autoantibodies against the acetylcholine receptors are present in the majority of MG patients (AChRs). Muscle-specific kinase (MuSK), low-density lipoprotein receptor-related protein 4 (Lrp4), and agrin are among the less frequently found autoantibodies. The downregulation, destruction, functional blockage, or disruption of AChR clustering in the postsynaptic membrane are all ways in which these autoantibodies interfere with cholinergic transmission between nerve terminals and muscle fibres. Fatigable muscle weakness, which may affect the ocular, bulbar, respiratory, and limb muscles, is the primary clinical symptom of MG. Depending on the autoantibody's kind and whether a thymoma is present, there are different clinical symptoms. By changing the immune homeostasis processes that stop the onset of autoimmune disorders like MG, a number of medications, including immune checkpoint inhibitors, penicillamine, tyrosine kinase inhibitors, and interferons, may cause de novo MG. Keywords: myasthenia, gravis, diagnosis, treatment

Case Report: The first reported case of pulmonary alveolar proteinosis with myasthenia gravis in a 27-year-old patient

Background: Pulmonary alveolar proteinosis is a very rare diffuse lung disease characterized by the accumulation of amorphous and periodic acid Schiff-positive lipoproteinaceous material in the alveolar spaces due to impaired surfactant clearance by alveolar macrophages. Three main types were identified: Autoimmune, secondary and congenital. Pulmonary alveolar proteinosis has been previously reported to be associated with several systemic auto-immune diseases. Accordingly, we present the first case report of pulmonary alveolar proteinosis associated with myasthenia gravis. Case: A 27-year-old female patient, ex-smoker, developed a dyspnea on exertion in 2020. The chest X-ray detected diffuse symmetric alveolar opacities. Pulmonary infection was ruled out, particularly COVID-19 infection. The chest scan revealed the “crazy paving” pattern. The bronchoalveolar lavage showed a rosy liquid with granular acellular eosinophilic material Periodic acid-Schiff positive. According to the lung biopsy results, she was diagnosed with pulmonary alveolar proteinosis. The granulocyte macrophage colony-stimulating factor autoantibodies were negative. Nine months later, she was diagnosed with bulbar seronegative myasthenia gravis, confirmed with the electroneuromyography with repetitive nerve stimulation showing significant amplitude decrement of the trapezius and spinal muscles. She was treated with pyridostigmine, oral corticosteroids and azathioprine. Given the worsening respiratory condition of the patient, a bilateral whole lung lavage was performed with a partial resolution of symptoms. Thus, this previously unreported association was treated successfully with rituximab, including improvement of dyspnea, diplopia and muscle fatigability at six months of follow-up. Conclusions: This case emphasizes on the possible association of auto-immune disease to PAP, which could worsen the disease course, as the specific treatment does not exist yet. Hence, further studies are needed to establish clear-cut guidelines for PAP management, particularly when associated to auto-immune diseases.

On-field low-frequency fatigue measurement after repeated drop jumps.

Purpose: Monitoring fatigue is now commonly performed in athletes as it can directly impact performance and may further increase the risk of injury or overtraining syndrome. Among the exercise-induced peripheral alterations, low-frequency fatigue (LFF) assessment is commonly restricted to in-lab studies. Measuring LFF on-field would allow athletes and coaches to assess muscle fatigability on a regular basis. The aim of the present study was therefore to validate a new portable device allowing quadriceps LFF assessment in the field. Methods: LFF was assessed in 15 active and healthy participants before (PRE) and after (POST) a series of drop jumps. LFF was assessed, thanks to a dedicated device recording evoked force to muscle submaximal electrical low- and high-frequency stimulation. Changes in the low- to high-frequency force ratio (further referred to as Powerdex® value) were compared to the changes in the ratio of evoked force induced by paired-pulse femoral nerve electrical stimulation at 10 and 100Hz (i.e., DB10/DB100 ratio). Maximal voluntary contraction (MVC) and voluntary activation (VA) were also measured. Results: MVC decreased (p < 0.001), whereas VA was not affected by the fatiguing task (p = 0.14). There was a decrease in the DB10/DB100 ratio (from 96.4% to 67.3%, p < 0.001) as well as in the Powerdex value (from 74.0% to 55.7%, p < 0.001). There was no significant difference between POST values (expressed in percentage of PRE values) of the DB10/DB100 ratio and Powerdex (p = 0.44), and there was a significant correlation between the changes in Powerdex® and DB10/DB100 (r = 0.82, p < 0.001). Conclusion: The on-field device we tested is a valid tool to assess LFF after a strenuous exercise consisting of repeated drop jumps as it evidences the presence of LFF similarly to a lab technique. Such a device can be used to monitor muscle fatigability related to excitation-contraction in athletes.

Effect of Mental Task on Sex Differences in Muscle Fatigability: A Review.

Previous research demonstrated that there are observable sex differences in developing muscle fatigue when mental task during fatiguing activity is present; however, there is no available review on this matter. Therefore, this review aimed to summarize the findings of previous studies investigating the effect of mental task on muscle fatigue in men and women. To conduct the review, we utilized searches using the electronic databases Web of Science, PubMed, Scopus, and EBSCO Cinahl Ultimate. The studies included had no limited publication date and examined the effects of mental task on muscle fatigue in a healthy adult population of any age. The evaluation was performed using the following criteria: time to failure, or subjective scale in various modifications (visual analog scale—VAS, rate of perceived effort—RPE, rate of perceived fatigue—RPF, rate of perceived discomfort—RPD). A total of seven studies met the set criteria, which were subsequently analyzed. Heavy mental task (more demanding math tasks) can reduce the time to failure for both men and women, with the reduction being more pronounced for women than for men. For light mental task (simple math tasks), no reduction in time to failure was observed to a great extent. The mental task in any of the included studies did not affect the subjective perception of fatigue, effort, discomfort, or pain. Although the studies investigating the effect of mental task on sex differences in muscle fatigability are limited, based on our findings we can assume that in jobs requiring heavier mental task, women may be more prone to the faster development of muscle fatigue; thus, employers might consider paying attention to the possibility of adequate rest.

ROLE OF AYURVEDA IN THE MANAGEMENT OF MYASTHENIA GRAVIS: A CASE STUDY

Myasthenia Gravis (MG) is a neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness with fatigue. The underlying defect in diseases is a decrease in the number of available acetylcholine receptors (AChRs) at postsynaptic neuromuscular junctions due to the binding of autoantibody at acetylcholine receptors. The most commonly and firstly affected muscles are those of the eyes, i.e., ocular muscles leading to drooping of eyelids because of more availability of receptors in less surface area of muscle, later leads to symptoms like difficulty in swallowing leading to (dysphagia), Difficulty to speak (dysarthria), other skeletal muscles fatigability etc. In Ayurveda, we cannot correlate to any particular diseases, but it can be understood in view of upahata dhatu ushma, srotas and marutha, respectively, leading to avarana to the normal functioning of vata. The present study was conducted to determine the efficacy of Ayurvedic management in Myasthenia gravis. In this paper, a case of 47 years old female who was diagnosed with myasthenia gravis (MG) with autoimmune hypothyroidism for 13 years was reported to complain of drooping of eyelids, pain and stiffness at the nape of the neck and bilateral shoulder joints, disturbed sleep, reduced appetite, with occasional diplopia, dysphagia, which got aggravated for six months, hence she approached OPD of SKAMCH&amp;RC, Bengaluru. Considering the signs and symptoms patient was treated on the line of kaphavruta vata, and by considering urdwajatrugata lakshana shirodhara, greevabasti along with nasya line of treatment was adopted, and when a patient got relief in her symptoms, and she was wanted to continue her treatment hence virechana was adopted for sroto shodhanartha. Treatment shows significant improvement in her symptoms without any side effects.