[Music] hello I'm Dr kadam nagpal head of neuroimmunology and movement disorders at manipal dwara so today I'm going to talk about a ailment myia gravis so masag gravis is basically an immune mediated neuromuscular Disorder so what happens that there are certain antibodies uh in the patient's blood which attack against the transmission which happens from the nerve to the muscle the transmission of the nerve and muscle is being carried out by a chemical known as atile choline and what happens that in this ailment there are antibodies which get developed against atile choline so these antibodies attack against atile choline thereby inhibiting the transmission from the nerve to the muscle resulting in a neuromuscular weakness so usually the patient often complains about fluctuating problems or fluctuating weakness like drooping of eyeballs there would be double vision double vision can happen on seeing on the sides or from uh looking from up to down there could be swalling difficulty there could be a nasal twang in the speech there could be nasal regurgitation of uh food and liquids and patients might just come up with sometimes respiratory muscle weakness and generalized weakness of all the limbs so identification of this uh fluctuating type of weakness is very important because once we have diagnosed this ailment the treatment is often very rewarding and very beneficial to the patient so once we uh there is a clinical examination and clinical evaluation which we perform then we perform uh electrophysiological testing and then we put the patient through a drug trial also so we see for the benefit of the medication when the medication is being given so this medication is basically an analog of atile choline and whenever this medication is given we see that the weakness dramatically gets uh responded and the patient's benefit is immediately visible and in order to suppress the antibody uh crisis in the patient's body we often give immunosuppressants or steroids accordingly to the patient habitus and patient profile the diagnosis of this particular ailment as I said is very rewarding because the benefit is almost immediate and we see the benefit that once the patient is being just coming with so much of weakness so much of droop open the eyelids and double vision and the moment we give this medication uh the response is very immediate and uh we see that the patient often gets a benefit on an immediate basis so the importance of this particular ailment is to diagnose it first and then treat it first many a times we see that this ailment is left undiagnosed because of which it keeps on progressing and starting from the lids the patients usually the ailment starts from the eyelids and the patients uh often come up with a generalized body weakness because of tendency to remain undiagnosed for this a thanks a lot and for any neuroimmunological disorders or autoimmune disorders in neurology uh you can contact manipal hospital dwara we run a dedicated OPD on Tuesdays from 2: to 4:00 p.m. for neuroimmunologic clinics thank you [Music]