For four years, a 42-year-old New York man underwent biweekly blood treatments, had chest surgery to remove his thymus gland, and gained 80 pounds and became hypertensive due to medication that he took for a diagnosed neuromuscular disorder (myasthenia gravis) that he did not have. He endured 74 unnecessary medical treatments for the potentially fatal medical condition that his former neurologist misdiagnosed.
The man began experiencing sudden unexplained falls in 2004 and sought diagnosis and treatment from a neurologist at a New York hospital. The neurologist told the man that he had myasthenia gravis and needed aggressive medical treatment. It was not until 2009, when the neurologist left the hospital to become Chief of Neurology at another New York hospital, that the man began treating with another neurologist who diagnosed his condition as cataplexy that could be treated with medication. Since his cataplexy diagnosis and treatment with appropriate medication, the man has not fallen.
The man’s New York medical malpractice case against his former neurologist, alleging misdiagnosis and medical negligence, resulted in the medical malpractice jury’s verdict in his favor in the amount of almost $4 million. The medical malpractice defendant has vowed to appeal the verdict against him.
What Is Myasthenia Gravis?
Myasthenia gravis (literally, “grave muscle weakness”) is a chronic autoimmune neuromuscular disease caused when antibodies block, alter, or destroy the receptors for the neurotransmitter called acetylcholine, which thereby prevents muscle contraction, and is characterized by varying degrees of weakness of the voluntary muscles of the body that increases during periods of activity and improves after periods of rest. Muscles that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often (but not always) involved; muscles that control breathing and neck and limb movements may also be affected. Despite its name, most people with myasthenia gravis have a normal life expectancy.
In adults with myasthenia gravis, the thymus gland remains large and is abnormal. Some people with myasthenia gravis develop thymomas (tumors of the thymus gland), which are generally benign but can become malignant. The relationship between the thymus gland and myasthenia gravis is not yet fully understood (some researchers believe that the thymus gland may give incorrect instructions to developing immune cells, ultimately resulting in autoimmunity and the production of the acetylcholine receptor antibodies, thereby setting the stage for the attack on neuromuscular transmission).
The first noticeable symptom is typically weakness of the eye muscles although some people may have difficulty in swallowing and slurred speech. The degree of muscle weakness varies greatly among people, from a localized form limited to eye muscles (ocular myasthenia) to a severe form in which many muscles are affected (sometimes including muscles that control breathing). Symptoms may include a drooping of one or both eyelids (ptosis), blurred or double vision (diplopia) due to weakness of the muscles that control eye movements, unstable or waddling gait, a change in facial expression, difficulty in swallowing, shortness of breath, impaired speech (dysarthria), and weakness is the arms, hands, fingers, legs, and neck.
Myasthenia gravis occurs in all ethnic groups, in both genders, and most commonly affects young adult women (under 40) and older men (over 60). It is not directly inherited or contagious but occasionally occurs in more than one member of the same family.
Myasthenia gravis can generally be controlled with therapies to help reduce and improve muscle weakness, including medications that help improve neuromuscular transmission and increase muscle strength, and immunosuppressive drugs that improve muscle strength by suppressing the production of abnormal antibodies.
The surgical removal of the thymus gland (thymectomy), which often is abnormal in individuals with myasthenia gravis, reduces symptoms in some people without thymoma and may cure some people (stable, long-lasting complete remission may occur in about 50% of people who have thymectomy); thymectomy is recommended for individuals with thymoma.
What Is Cataplexy?
Cataplexy is a condition that causes a sudden loss of muscle tone while awake. The muscle weakness may affect only certain parts of the body or the whole body. Strong emotions often trigger the weakness, which may last seconds or minutes. Cataplexy is sometimes associated with narcolepsy, a disorder that causes periods of extreme daytime sleepiness and may also cause muscle weakness — most people who have narcolepsy have trouble sleeping at night and some people fall asleep suddenly, even if they are in the middle of talking, eating, or another activity.
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