My child always says he is bored. What's going on?

In the eyes of adults, every child is full of energy and never gets tired. If the child says that he has no strength, consider whether it is a physical reason. Colds, fevers, etc. can cause lack of strength, but they will get better after treatment. If your child often complains about being tired, you need to consider other factors. Myasthenia gravis is a very obvious problem.

Myasthenia gravis (MG) is an autoimmune disease caused by dysfunction of neuromuscular junction transmission. The main clinical manifestations are partial or systemic skeletal muscle weakness and fatigue. The symptoms worsen after activity and are relieved after rest. The prevalence is 77-150/1 million, and the annual incidence is 4-11/1 million. The incidence rate in females is higher than that in males, about 3:2. The disease occurs in all age groups, mostly in children aged 1 to 5 years old.

Second cause

The causes of myasthenia gravis are divided into two categories. One is congenital hereditary, which is extremely rare and has nothing to do with autoimmunity; the second is autoimmune disease, which is the most common. The cause of the disease is still unclear, but it is generally believed to be related to infection, drugs, and environmental factors. At the same time, 65% to 80% of myasthenia gravis patients have thymic hyperplasia, and 10% to 20% have concomitant thymoma.

Three clinical manifestations

In the early stages of myasthenia gravis, patients often feel soreness or discomfort in the eyes or limbs, or blurred vision, and are easily fatigued. Fatigue is aggravated by hot weather or menstruation. As the disease progresses, skeletal muscles become noticeably tired and weak. A notable feature is that muscle weakness worsens in the afternoon or evening after exertion and improves in the morning or after resting. This phenomenon is called "lighter in the morning, heavier in the evening."

1. Myasthenia gravis patients may have skeletal muscles all over the body affected, and may have the following symptoms

(1) Drooping eyelids, blurred vision, diplopia, strabismus, and inflexible eye movement.

(2) Expression is indifferent, with a wry smile on the face, lisp, difficulty in articulation, and often accompanied by nasal voice.

(3) Weakness in chewing, coughing when drinking water, and difficulty swallowing.

(4) Weak neck, difficulty raising the head, and inability to turn the neck or shrug the shoulders.

(5) Difficulty raising arms, combing hair, climbing stairs, squatting, and getting into a car.

2. Clinical classification

(1) Modified Osseman classification: ① Type I ocular muscle type; ② Type IIA mild systemic type, in which the limb muscles are often affected along with the ocular muscles, without the manifestation of pseudobulbar palsy, i.e., no difficulty in chewing and swallowing, and no slurred articulation. ③ Type IIB: The limb muscles are often affected along with the eye muscles, with symptoms of pseudobulbar palsy, and breathing difficulties usually occur within half a year. ④Type III (severe radical type) develops rapidly, usually developing into breathing difficulties over weeks or months. ⑤Type IV (delayed severe type) usually evolves from type I, type IIA, and type IIB in about 2 years. ⑥ Type V muscular atrophy, rare.

(2) Myasthenic crisis refers to a critical phenomenon in which the patient's condition suddenly worsens rapidly, with breathing difficulties and life-threatening conditions due to some reason during the course of the disease. Depending on the different causes, MG crisis is usually divided into three types: ① Myasthenic crisis is mostly caused by the development of the disease itself. It can also be triggered by infection, excessive fatigue, mental stimulation, menstruation, childbirth, surgery, and trauma. The clinical manifestations are sudden aggravation of the patient's muscle weakness symptoms, weakness in swallowing and coughing up sputum, difficulty breathing, often accompanied by irritability, profuse sweating and other symptoms. ② Cholestatic crisis occurs in patients who have been taking large doses of pyridostigmine bromide for a long time, or who have taken too much at one time. Before the crisis occurs, they often show nausea, vomiting, abdominal pain, diarrhea, sweating, tearing, cold and clammy skin, increased oral secretions, fasciculation, and mental symptoms such as agitation and anxiety. ③ The dosage of "pyridostigmine bromide" remained unchanged during the recurrent crisis, but the drug suddenly became ineffective and severe breathing difficulties occurred. It may also be caused by infection, electrolyte imbalance or other unknown reasons.

Among the above three crises, myasthenic crisis is the most common, followed by reverse crisis, and true cholestatic crisis is very rare.