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Extremely helpful member
May 11, 2008
Los Angeles
Hi ... I have no idea what I'm talking about on anything medical, but I found the following article on the Wiley InterScience website, quoting an article from the journal "Muscle & Nerve," Vol 36, Issue 3, pp 304-399, 12 Feb 2007.

I know that my neuros are right and I have ALS, but because of my double & blurred vision, I'm still poking around in Myasthenia Gravis websites. What interests me in the following article is that these doctors reversed muscle atrophy. I have never heard of that before. If they can reverse muscle atrophy in its rare appearance in MG, could it not be done in ALS?

It wouldn't reverse the ALS disease process, of course, but slowing or reversing atrophy would surely lead to a better quality of life.

Of course, I have no idea what "neurogenic muscle atrophy" is or if it is the same thing as ALS atrophy.

Case of the Month
Myasthenia gravis presenting with unusual neurogenic muscle atrophy
Miharu Samuraki, MD 1 *, Eisuke Furui, MD, PhD 1, Kiyonobu Komai, MD, PhD 1, Masaharu Takamori, MD, PhD 2, Masahito Yamada, MD, PhD 1
1Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
2Neurological Center, Kanazawa-Nishi Hospital, Kanazawa, Japan

email: Miharu Samuraki ([email protected])

*Correspondence to Miharu Samuraki, Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa 920-8640, Japan

histochemical studies • muscle atrophy • myasthenia gravis • neurogenic changes • single-fiber EMG

We report a patient with myasthenia gravis who had neurogenic muscle atrophy in association with external ophthalmoplegia and weakness of the upper limbs. Neurogenic changes in the limb muscles were found on needle electromyography and histological studies. Symptoms improved and atrophy of the limbs diminished after intravenous immunoglobulin and oral corticosteroid therapy. We concluded that functional interruption of the neuromuscular junction caused the neurogenic muscle atrophy and that this was relieved by appropriate therapy. Muscle Nerve, 2007

Accepted: 4 January 2007[/I]
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That is interesting, and I, too, wish I had more than my practically non-existent medical knowledge, even understanding terminology would help a lot! Maybe someone like Wright or Jeff will weigh in on this...
MG is an autoimmune disease which IVIG can treat. The mechanism of ALS although unknown hasn't been responsive to IVIG. In MG it is the neurotransmitter that is blocked or missing where in ALS the neurons die. Think of it like the phone lines in your town. In MG they come and unplug your phone line from the wall in your home. With ALS they cut down all the telephone poles and pull the lines out of the whole block.

Reversing atrophy in and of itself is simple. All that needs to be done is to exercise the muscle. The problem in MG or ALS is that when you contract the muscle only a portion of the muscle is getting the signal to move and working. The rest is just along for the ride. Figuring out how to get the signal back to the rest of the muscle is a huge undertaking in ALS.

Using the telephone analogy again with MG you are given IVIG which simply plugs the phone line back in the wall and you're up and running. With ALS you need to get a crew together to replace all the poles, run new lines and then reconnect service. In the meantime whoever ordered the lines removed has their team tearing down whatever you try to rebuild. At some point stem cells may be able to rebuild the neurons but until the mechanism is found that is killing them off they won't be a fix.

To avoid some of the stem cell arguments this may create. Stem cells may be a means to cure/treat ALS at some point in the future. As of now nothing is proven. People claim improvements shortly after treatment which I find questionable. It can take a long time to grow some of the pathways as some are literally several feet in length. There is no way to ensure that stem cells go where they are needed, grow into neurons and most importantly that they don't suffer the same fate as the previous neurons should they do so.
Very apt description, Jeff. You did a good job for someone like me, who likes the neurology 101 version! :-D
Yes, thank you Jeff, the analogy you used was easy to understand! :)
Thanks Jeff. I believe in the KISS principle. That was easy to understand and right on the money.
Great explanation, Jeff. Thanks!
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