Chu Eric Chun Pu, Bellin David
New York Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, China.
AME Case Rep. 2019 Apr 22;3:9. doi: 10.21037/acr.2019.04.04. eCollection 2019.
Myasthenia gravis (MG) is an autoimmune disorder, caused by circulating antibodies against the acetylcholine receptor (AChR) and associated proteins. Anticholinesterase medications and immunomodulating therapies are the mainstays of current treatment. Presented here is a case of a 51-year-old female who had been diagnosed with MG based on symptoms and continued elevation of antibody to AChR (anti-AChR) by her family physician. The patient's anticholinesterase medication was halted due to significant side effects affecting bowel function. She only received acupuncture treatment in the past 4 months prior to this presentation. Myasthenic symptoms deteriorated and the anti-AChR titer kept elevating after stopping medication. She originally came to us due to neck and back pain rather than myasthenic complaints. This case is interesting that her back pain and myasthenic symptoms went into complete remission within 1 month of initiating chiropractic adjustment. The concomitant recession of the myasthenic symptoms raises considerable interest for the mystery of MG, including the causal link between stress and autoimmune disease, the role of ACh in immune regulation, and the possible mechanisms of disease amelioration. Further studies would shed more light on the efficacy of various modalities in treating MG.
重症肌无力(MG)是一种自身免疫性疾病,由针对乙酰胆碱受体(AChR)及相关蛋白的循环抗体引起。抗胆碱酯酶药物和免疫调节疗法是目前治疗的主要手段。本文介绍了一例51岁女性病例,其家庭医生根据症状及抗AChR抗体(抗AChR)持续升高诊断为MG。由于影响肠道功能的严重副作用,该患者的抗胆碱酯酶药物被停用。在此次就诊前的4个月里,她仅接受了针灸治疗。停药后,肌无力症状恶化,抗AChR滴度持续升高。她最初因颈部和背部疼痛前来就诊,而非肌无力相关主诉。该病例有趣之处在于,在开始整脊调整后的1个月内,她的背痛和肌无力症状完全缓解。肌无力症状的同时缓解引发了人们对MG奥秘的浓厚兴趣,包括压力与自身免疫性疾病之间的因果联系、ACh在免疫调节中的作用以及疾病改善的可能机制。进一步的研究将更清楚地揭示各种治疗方式对MG的疗效。