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Category: Case Studies
Date 23-jul-2005
Case Title Chiropractic care of a pediatric patient with myasthenia gravis.
Author Alcantara J, Plaugher G, Araghi HJ
Main Condition/ Disease  Myasthenia Gravis
Source Journal of Manipulative Physiol Ther. 2003 Jul-Aug;26(6):390-4
Abstract OBJECTIVE: To describe the chiropractic care of a pediatric patient with complaints associated with myasthenia gravis.Clinical features A 2-year-old girl was provided chiropractic care at the request and consent of her parents for complaints of ptosis and generalized muscle weakness (ie, lethargy), particularly in the lower extremities. Prior to entry into chiropractic management, magnetic resonance imaging of the brain and acetylcholine receptor antibody tests were performed with negative results. However, the Tensilon test was positive and the diagnosis of myasthenia gravis was made by a pediatrician and seconded by a medical neurologist.Intervention and outcome The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxation complexes in the upper cervical and sacral spine. The patient's response to care was positive and after 5 months of regular chiropractic treatment her symptoms abated completely. CONCLUSION: There are indications that patients suffering from disorders "beyond low back pain" as presented in this case report may derive benefits from chiropractic intervention/management.
Summary Myasthenia gravis is characterised by specific muscle weakness and fatigued skeletal muscles. Ocular motor disturbances, ptosis or diplopia, are the initial symptom of myasthenia gravis many patients. Others experience pharyngeal muscle weakness, difficulty chewing, swallowing, or talking. The disease is chronic and involves remissions and exacerbations in symptoms.
This case is of a 2 y.o. female who 6 months previous to a chiropractic visit was in an automobile accident. Otitis media (ear infections) reuslted in the child being presenteded to a pediatrician. Soon after ptosis (medical term for drooping eyelids) in the right eye was noticed. A medical diagnosis of myasthenia gravis was made and the parents were informed that nothing could be done.
The child's condition worsened over the next 5 months. She was not on any medications.
Chiropractic examination revealed temperature asymmetry at C0-C1, C1-C2. Sub-occipital muscles were hypertonic (more tense) between C0-C1 and C1-C2. Fixation (upper cervical sunluxation) was at C0-C1 and left head tilt was evident.
Chiropractic intervention involved adjustment to the offending vertebral segments in the upper cervical spine. The atlas was adjusted 20 times and the sacrum about 6 times. Following 5 months of chiropractic care the child "had improved nearly 100%". Speech was normal and she could run for periods without fatigue.
Think of this case in light of what we know about upper cervical subluxations - accident (in this case, a car accident), head tilt, tensioned sub-occipital muscles, forward head carriage. There is a familiar thread here, and so it comes of no surprise that upper cervical chiropractic adjustment to the upper cervical spine resulted in significant improvements in the well being of this child. More research is required.
Keywords myasthenia gravis, upper cervical, chiropractic, sub-occipital, atlas subluxation

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