Myasthenia gravis / by Charles S. Myers.

Charles Samuel Myers

Date:: 1902?]

Credit: Myasthenia gravis / by Charles S. Myers. Source: Wellcome Collection.

11/46 page 313

$recall the remittent course, the deficiency of other movements in the former disease, however much the expressionless face and waddling gait may in rare instances recall the signs of the latter. Neuritis is seldom purely motor. Sensory affections are never well marked in myasthenia gravis. The knee jerks are often exaggerated in myasthenia gravis, never, at least for long, absent: they are diminished or absent in most cases of neuritis, while here the myasthenic reaction is unknown. Diphtheritic neuritis may present closely similar bulbar symptoms. The previous history and a possible presence of the reaction of degeneration should be looked to, and the ciliary muscle should be tested. Too many distinct diseases are included in Landry’s paralysis to permit of a satisfactory summary of the points of difference between it and myasthenia gravis. The extremely rapid course and the frequent sensory disturbances are important features in Landry’s paralysis. Neurasthenia differs from myasthenia gravis in yielding no true myasthenic reaction, and in presenting well-marked sensory symptoms. The distinction between the forms of periodic palsy, amyotrophic lateral sclerosis, and myasthenia gravis is usually clear. In the chronic variety of polio-encephalomyelitis, the fibrillar tremors and atrophy of the affected muscles, their changed responses to electrical stimuli, and the condition of the tendon reflexes are sufficient guides to a correct diagnosis. But in the acute form of this disease, in superior and inferior polio-encephalitis, and in certain toxic forms of apparently nuclear inflammations, when both ophthalmoplegia and bulbar symptoms may be present, their diagnosis from myasthenia gravis may present considerable difficulties. Usually the rapidity and mode of onset, the general mental condition, and the subsequent course of the disease indicate its real nature.’^ The myasthenic reaction is not confined to myasthenia gravis. Benedikt found in the hemiplegia of cerebral carcinoma an almost identical condition, called by him “ Beaction der Erschopfbarkeit,” and characterised by “ a diminishing reaction during faradic stimulation, the reaction at the onset possibly being excessive, normal, or defective.’ Brenner has described it in certain cases of apoplectic paralysis. It has also been observed in cases of muscular hypertrophy, chronic poliomyelitis, and Landry’s paralysis. Striimpell (^), however, points out that in myasthenia gravis the reaction produced is far more abruptly marked, and that it may be obtained in groups of muscles which at the time are not obviously paretic. The myasthenic reaction appears also to have been noticed in persons who suffer from a curious disease of Japan, called Kubimgaril Muira found, on stimulating ^ The subject is discussed at length hy Oppenheira {*”), pp. 145-155. ^ Kul)isagari literally means a man who droops his head. It is a disease which is found only in country peasants tending horses and cattle, manifests itself in paroxysmal attacks, and very closely resembles a Swiss malady described by Gerlier (“®) as “Une Epidemic de$

Myasthenia gravis / by Charles S. Myers.

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