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Orbital Lesions: this condition could be due to orbital small cell lung cancer.
tumors, abscess and inflammatory pseudotumors.
Patients experienced paralysis of extraocular muscle, Progressive spinal muscular atrophy (PSMA): PSMA
conjunctival hyperemia, exophthalmos and edema in is a rare type of motor neuron disease, patients of
eyelids. This could be confirmed by orbital MRI, CT which experience flaccid, weakness and atrophy of
and ultrasonic scans. extremities, muscle fasciculations, reduction or loss
of deep tendon reflexes. EMG result shows that there
Graves’ disease: this is a thyroid-related autoimmune is denervation. At resting stage, there is fibrillating
disease, patients of which experience hyperthyroidism potentials and positive peak waves, and even
or hypothyroidism, eyelid lag and weakness of fasciculation potentials in certain cases. Duration
extraocular muscle. In orbital CT scan, extraocular of potentials of motor units is broaden, volatility
muscle is swelling. There is positive detection of TSH and number of multiphase wave increase during
receptor antibody, namely TRAb. mild muscle contraction. However, the potentials
decrease in amplitude and present as single or mixed
Meige syndrome: this is an extrapyramidal phases during maximal contraction. Moreover, the
disorder, patients of which experience unilateral conduction velocity of sensory neuron is normal.
or bilateral blepharospasm, reduction of eye
fission, non-rhythmic tonic spasms at face, jaw Polymyositis: this is a multifactorial inflammation
and tongue. Dopamine receptors antagonists or in interstitial area of skeletal muscle, patients of
local administration of type A botulinum toxin can which experience progressive flaccid and weakness
improve these symptoms. of muscle and pain. EMG indicates myogenic lesion
and cardial level of creatine kinase is significantly
Generalized MG elevated. This disorder could be confirmed by biopsy,
which is curable by corticosteroids.
Guillain-Barré syndrome: this is an immune-
mediated acute inflammatory peripheral neuropathy, Botulism: botulinum toxin damages the presynaptic
patients of which experience flaccid and weakness of membrane of neuromuscular junctions, leading to
limbs, reduction or loss of tendon reflexes. By EMG, extraocular muscle paralysis, dilation of pupil but
the motor neuronal function presents as increment retarded light reflex, weaknesses in swallowing
of conduction latency, slower innervation velocity, and chewing, dysarthria and symmetrical flaccid
blockade and discrete and abnormal waveform. paralysis of limbs. If respiratory muscles are affected,
there could be Lambert-Eaton myasthenic syndrome
Chronic inflammatory demyelinating polyneuropathy liked autonomous signs. There is no significant
(CIDP): CIDP is an immune-mediated disorder of the decrement of EMG in the low frequency repetitive
peripheral nervous system, the patients of which nerve stimulation. However, there is increment of
experience flaccid and weakness of extremities, amplitude or no changes in high frequency repetitive
hypoesthesia, reduction or loss of deep tendon nerve stimulation, which is dependent on the severity
reflexes. There is a reduction of conduction velocities of poisoning. Diagnosis could be confirmed by
in motor and sensory neurons, abnormal and block isolating and identifying the botulinum toxin in the
waveform. There is also protein-cell separation in consumed food.
CSF. Diagnosis could be confirmed by biopsy of PNS
tissue. Metabolic myopathy: This is a disorder led by the
compromised muscle metabolism, lipid metabolism or
Lambert-Eaton syndrome: this is an autoimmune lesion of mitochrondria, patients of which experience
disorder mediated with the antibodies attacking flaccid and weakness of limbs and fatigue, reduction
the presynaptic voltage-gated calcium channels, the or loss of deep tendon reflexes. There is myogenic
patients of which experience muscle weakness and lesion in EMG and normal or slight elevation of
fatigue of proximal limbs, muscle tone enhancement cardiac enzymes levels. Diagnosis could be confirmed
after brief activity but weakness after sustain by muscle biopsy and gene tests.
activities, autonomic nervous system sign, such as dry TREATMENT OF MG
mouth, orthostatic hypotension, slow gastrointestinal
motility, pupil dilation, etc. In EMG test, low frequency Therapeutic approaches
repetitive stimulation induces small amplitudes of
CMAP but increased amplitudes in high frequency Cholinesterase inhibitors
repetitive stimulation. This disorder commonly
happens with certain malignancies, particularly Such inhibitors are the first-line drugs for MG

4 Neuroimmunol Neuroinfammation | Volume 3 | Issue 1 | January 20, 2016