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Case Study 4

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Case Study 4

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1.) The patient, Jill, has been experiencing difficulty chewing and double vision due to
the condition of Myasthenia Gravis which she was diagnosed with by doctors after an
Electromyography, and a blood test was performed. According to the Nation Institute of
Neurological Disorders and Stroke, Myasthenia Gravis is an autoimmune disease that
causes voluntary muscle weakness, also known as atrophy, due to an “error in how
nerve signals are sent to muscles, specifically when communication between the nerve
and muscle is interrupted at the neuromuscular junction.” In more basic terms, when
someone is diagnosed with Myasthenia Gravis it means that their immune system
attacks the tissue in the neuromuscular junction. This is where the neurotransmitter
acetylcholine meets the motor end plate of the muscle fibers to pass along the action
potential needed to enact voluntary muscle movement. An autoimmune disease can be
defined as when an individual's immune system becomes overactive and begins not
only attacking infections and other harmful substances that enter the body but also
healthy cells and substances the body needs to maintain homeostasis and overall
health and wellness. The EMG test performed showed that Jill had “progressive
weakness and decreased amplitude of contractions” of the muscles in her arms that
were noticeably reversed when the drug Tensilon, as known as edrophonium, which is
an acetylcholinesterase inhibitor, was given to her intravenously, and the blood test
showed high levels of anti-acetylcholine antibodies in her plasma. Both of these test
findings are significant indications of Myasthenia Gravis.

https://www.ninds.nih.gov/health-information/disorders/myasthenia-gravis


2.) Acetylcholine is a type of neurotransmitter. A neurotransmitter is a chemical that
carries messages throughout the body’s neurons and cells. Acetylcholine is a
neurotransmitter specifically useful in the voluntary contraction of muscles. When an
individual wants to move a muscle voluntarily first the brain sends a message to the
muscles through the nerves with neurotransmitters. Nerve impulses and
neurotransmitters are sent down along neurons and eventually reach the synaptic end
bulb. The synaptic cleft or the synaptic gap is the area between a neuron and a muscle.
Vesicles containing the neurotransmitter acetylcholine are released from the end bulb,
move through the synaptic cleft, and bind to the receptors on the motor end plate
muscle cells. Once this happens channels are opened within the muscle fibers to allow
sodium to enter the muscle to aid in the binding of actin and myosin. Later when the
action potential needs to be stopped Acetylcholine is broken down within the synaptic
cleft and removed by an enzyme called Acetylcholinesterase.

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