Mjesec juni je posvećen podizanju svijesti o mijasteniji gravis…
Mijastenija gravis se manifestuje patološkom zamorljivošću mišića, i promjenjivim slabostima mišića. Najčešći simptomi su spušten kapak, duple slike i slabost mišića koja je promjenjiva tokom dana. Simptome pogoršava aktivnost mišića, a odmor ih smanjuje. Često se javlja otežan govor, otežano gutanje, a kod 10% bolesnika mogu biti zahvaćeni disajni mišići sa otežanim disanjem i životnom ugroženoću (mijastenična kriza). Postoje dva oblika , takozvana okularna/očna forma i generalizirana forma bolesti.
Mijastenija gravis je autoimuno oboljenje, gdje sam organizam stvara antitijela na acetilholinske receptore razarajući ih i na taj način dovodi do blokade neuromišićne spojnice (postsinaptička blokada) i prekida prenosa impulsa na mišić. Okidač za proizvodnju antitijela je nepoznat ali je bolest često povezana sa uvećanjem grudne žlijede (timusa), autoimunim oboljenjem štitne žlijezde i drugim autoimunim bolestima kao što su reumatoidni artritis, sistemski lupus, perniciozna anemija..
Bolest se najčešće javlja u odrasloj dobi i to kod mladih žena (između 20-40 godina) i starijih muškaraca (50-80 godina). Može se javiti i u djetinjstvu kao kongenitalni (nasljedni) oblik bolesti.
Dijagnoza se postavlja na osnovu kliničke slike, neurološkog pregleda, a potvđuje se dokazivanjem prisustva antitijela na acetilholinske receptore ( AchR, najčešće), antiMUSK i LRP4. Dodatni testovi su test neuromišićne spojnice (EMG) i prostiogminski test, CT grudnog koša za detekciju hiperplazije ili tumora grudne žlijezde (timus).
Liječenje je doživotno, a uključuje antiholinesterazne lijekove (mestinon), timektomiju (odstranjivanje timusa), kortikosteroide, imunosupresivne lijekove. U slučaju mijastenične krize koja može biti životno ugrožavajuća primjenjuje se plazmafereza ili intravenski imunoglobulini, eventualno disajna potpora (mehanička ventilacija).
dr Nadira Hodžić Ibrišević, spec. neurolog
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