neurology

Myasthenia Gravis Awareness Month: 4 Things to Know

lazy-eyeJune is Myasthenia Gravis (MG) Awareness Month. So we asked Emory neurologists Taylor Harrison, MD, and Vita Kesner, MD, to share some information about MG.

What is Myasthenia Gravis?

Myasthenia gravis (pronounced My-as-theen-ee-a Grav-us) is a serious neurological disease caused when a person’s immune system is too active and makes antibodies that cause muscle weakness. Antibodies are proteins made by white blood cells and their primary role is to help the immune system recognize and fight bacteria and viruses. In myasthenia gravis, the antibodies affect the ability of nerve signals to trigger the muscles to contract, resulting in muscle weakness. Approximately 15% of patients with myasthenia gravis have weakness that is limited to the face and eye muscles, and 85% have more generalized weakness which can affect speech, swallowing, arm and leg muscles, as well as breathing muscles. The weakness often fluctuates, tending to be better after rest and worse with sustained physical activity. In some people, the weakness remains very mild but it can be disabling or even fatal by causing weakness of breathing muscles.

How is this condition diagnosed and by whom?

A neurologist plays a critical role in both the diagnosis and management of patients with myasthenia gravis. Many people may display symptoms for some time before a final diagnosis is made.

A diagnosis of myasthenia gravis can be confirmed by the presence of antibodies in the blood. There are different types of antibodies that the doctor may look for. The doctor may also evaluate the function of the thyroid gland, because problems with the thyroid can sometimes look like myasthenia and if a patient has myasthenia, than thyroid problems can make the myasthenia worse. Other important tests include electrical testing of the nerves and muscles. A highly specialized test called single fiber electromyography is another test that evaluates whether nerve signals are making muscle cells fire together, and is typically done when there is uncertainty if weakness is indeed related to a diagnosis of myasthenia gravis.

Is the thymus gland connected to an MG diagnosis?

If myasthenia gravis is confirmed, you doctor may order a CT scan of your chest to look at your thymus gland in your chest. The thymus gland is an important organ in the development of the immune system at a very young age, but stops working as you get older and enter the teenage years. A small percentage of patients with myasthenia may actually have a tumor to the thymus gland, which requires surgery. In some patients with myasthenia who have no tumor surgery to take out the thymus gland may be considered, with the idea that the thymus gland is overactive and removal may improve the myasthenia symptoms. The doctor may also order testing of your breathing to make sure the breathing muscles are strong.

What medications are used for treatment?

There are a number of medications used to treat myasthenia gravis, and it is important to recognize that myasthenia gravis is treatable. Medications such as pyridostigmine (Mestinon®) is used to help with weakness, it helps the nerve signals get to muscles better. Corticosteroids (e.g., prednisone) and immunosuppressant agents (e.g., Imuran®) may be used to suppress the abnormal action of the immune system that occurs in myasthenia gravis. Intravenous immunoglobulins (IVIg) and plasmapheresis, or plasma exchange, may be especially useful during severe myasthenia gravis weakness. IVIG affects the function or production of the abnormal antibodies and plasmapheresis is a procedure that removes the abnormal antibodies from the plasma of the blood. The best choice of treatment for each patient is determined by a neurologist according to the severity of the myasthenia gravis and other existing medical conditions.

If you suspect you have MG or have been diagnosed and would like a second opinion, you can make an appointment with Emory Neurology by calling 404-778-7777.

Stroke Awareness Month Events at Emory Healthcare

Stroke EventsAccording to the American Heart Association, stroke is the leading cause of adult disability in the United States. In recognition of May as National Stroke Awareness Month, Emory Healthcare encourages you to learn the signs, symptoms and risk factors for stroke. Mark your calendar for the following events:

Community Stroke Fair

When: Wednesday, May 13, 2015; 11:00 am to 2:00 pm
Where: Emory University Hospital Midtown Medical Office Tower Lobby
Why:

  • Learn the signs and symptoms of stroke
  • Free blood pressure screening
  • Ask a neurologist about stroke care
  • Hear about stroke rehabilitation programs
  • Speak to a pharmacist
  • Get your BMI checked
  • Free gift bags

5K Scrub Run and Community Health Festival

When: Saturday, May 16, 2015; 8 am to 11am
Where: Emory Johns Creek Hospital parking lot
Why:

  • Learn the signs and symptoms of stroke
  • Free glucose and cholesterol
  • Free blood pressure screening
  • Get your BMI checked

Stroke Awareness Fair

When: Tuesday, May 19, 2015; 10 am to 2 pm
Where: Emory Clinic Motor Lobby between buildings A and B
Why:

  • Learn the signs and symptoms of stroke
  • Understand how to manage blood pressure, exercise properly and maintain a healthy diet
  • Talk with experts about stroke prevention and response for suspected stroke

Stroke LIVE Chat

stroke-recovery-chat

 When: Thursday, May 28, 2015; 12:00 pm to 1:00 pm
 Where: Online
 Why:

  •  Learn about stroke recovery and rehabilitation from Dr. Samir Belagaje, stroke neurologist at Emory  University and Director of Stroke Rehabilitation at the Marcus Stroke Center. Dr. Belaje will answer  questions during a LIVE interactive chat.

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Stroke is an emergency. If you or someone around you is experiencing signs or symptoms of stroke, CALL 911 immediately.

Pituitary Tumors – Types, Treatments and More

pituitary glandYou or someone you know has been diagnosed with a Pituitary Tumor. So what’s next?

First, virtually all pituitary tumors are benign, that is to say they are not cancers, which is usually what comes to mind when the diagnosis “tumor” is made. They are certainly growths, hence the name tumor, and left untreated usually will get bigger. This will likely cause more symptoms and may become more complicated to treat.

The pituitary gland is a very important organ, so much so that it is called the “master gland” because it literally controls the functions of all the other endocrine (hormone-producing) glands such as the thyroid, adrenal, testis and ovaries, while also having a very key role in regulating metabolism and growth. In fact, without the pituitary or replacements for what it produces, life as we know it would not be possible. However, the pituitary is quite small, about a half-inch or the size of a kidney bean, and is located at the center of the base of the brain surrounded by very important anatomic structures.

Population studies suggest that pituitary tumors occur in about one-sixth of the population, but not all of these are symptomatic, and comprise about one-tenth of all brain tumors.

Broadly speaking, there are two types of pituitary tumors – those that are functionally-active, i.e. they produce one or more hormones in excess. Examples include, excess steroids (Cushing’s Disease), excess growth hormone (Acromegaly or Gigantism) or excess prolactin (Prolactinoma). The other category is functionally inactive, that may in fact lead to hormone deficiencies in addition to causing problems with vision as they grow. These medical conditions are relatively rare and not commonly encountered by the average physician, therefore if the diagnosis is suspected; referral to a specialist is usually made so the appropriate diagnostic tests and therapies can be initiated. These Pituitary centers will have an experienced team of key specialists, such as pituitary endocrinologists for diagnosis and medical treatment, neuroradiologists to interpret the images from MRI, neurophthalmologists who examine effects on vision, pituitary tumor neurosurgeon and ENT surgeons who jointly perform the critical surgery that may be required, as well as a host of other specialists to maximize the best outcomes.

Treatment options include medications for some functioning tumors, surgical removal of the tumor, highly-focused radiotherapy or sometimes close observation when treatment is not deemed necessary.

Most pituitary centers of excellence also have on-going clinical trials and active research programs that are advancing the field of pituitary tumor science, medicine and surgery.

For more information on how we are advancing the treatment of pituitary disorders, visit the Emory Pituitary Center website.

About Dr. Oyesiku

Nelson Oyesiku, MDNelson M. Oyesiku, MD, PhD, FACS, serves as Professor and Vice Chair, Department of Neurosurgery Director, Molecular Neurosurgery and Biotechnology Laboratory Program Director, Neurosurgery Residency Program Clinic and Co-Director of the Emory Pituitary Center. His clinical research focus is the surgical treatment and molecular biology of pituitary tumors. Dr Oyesiku has performed more than 1,500 surgeries for pituitary tumors and is one of a few surgeons in the U.S. and worldwide (and the first in Georgia) utilizing advanced 3-D endoscopic surgery for resection of pituitary tumors. This technology provides the surgeon with improved spatial resolution making surgery safer.

Dr. Oyesiku partners with Adriana Ioachimescu, MD, PhD, and a team of clinicians who collaborate in the diagnosis and treatment of patients with pituitary tumors at Emory’s Pituitary /Neuroendocrine Center. The Emory Pituitary/NeuroendocrineCenter has a nationwide and worldwide referral base and provides patients with comprehensive and personalized medical and surgical management of pituitary disorders. Specialists in Endocrinology, Neurosurgery, Neuroradiology, Neurophthalmology, Radiation Oncology, and ENT collaborate to provide state-of-the-art as well as novel advances in care and translational research.