Bulbar weakness not necessarily precedes weakness of skeletal muscles in myasthenia

Josef Finsterer, MD, PhD*, Scorza Fulvio A, MD, Scorza Carla A, MD

Bulbar weakness not necessarily precedes weakness of skeletal muscles in myasthenia

Josef Finsterer, MD, PhD*, Scorza Fulvio A, MD, Scorza Carla A, MD

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Josef Finsterer, MD, PhD*, Scorza Fulvio A, MD, Scorza Carla A, MD, “Bulbar weakness not necessarily precedes weakness of skeletal muscles in myasthenia”, ijmhs, vol. 10, no. 06, pp. 908–909, Jun. 2020.

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Abstract

With interest we read the article by Torres-Barrera et al.
about a 64yo male with dysphagia as presenting manifestation
of myasthenia gravis(MG). [1] We have the following
comments/concerns.
Dysphagia is not an uncommon feature of MG [2] and
has been repeatedly reported, even as initial manifestation
of MG. [3]
Neurological examination of the index patient revealed
“muscle weakness of the examined muscles”. [1] When did
it develop? The patient had an uneventful previous history,
except for dysarthria/dysphagia. [1] We should know which
skeletal muscles were weak, the degree of muscle weakness,
if there was worsening of weakness during daytime, and if
muscle weakness occurred before dysphagia, which is usually
the case. We also should know if dysphagia/dysarthria
occurred first and if there was dropped head syndrome or
respiratory muscle weakness, which frequently go along with
dysphagia/dysarthria in MG.
A highly sensitive tool for diagnosing MF is single-fiber
electromyography(SF-EMG). [4] We should know if any of
the affected/unaffected muscles were investigated by SFEMG
and if the jitter was increased. An increased jitter
may be found even in clinically unaffected muscles.
The patient responded favourably to azathioprine/
pyridostigmine. We should know if acetyl-choline
receptor antibodies(AchR-abds) titres declined upon
immunosuppression.

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Issue Vol. 10 No. 06 (2020): Innovative Journal of Medical and Health Science
Section Letter to Editor

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Bulbar weakness not necessarily precedes weakness of skeletal muscles in myasthenia

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