Myasthenia Gravis

1 What is Myasthenia Gravis?

The weakness and rapid fatigue of any of the muscles under your voluntary control is called Myasthenia gravis (my-us-THEE-nee-uh GRAY-vis). A breakdown in the normal communication between nerves and muscles is the cause of this disease.

There is no known cure for myasthenia gravis but treatment can help in relieving the symptoms such as double vision, weakness of arm and leg muscles, difficulties with swallowing, chewing, speech and breathing, and drooping eyelids.

It can affect any age but most commonly in men older than 60 and in women younger than 40.

2 Symptoms

Symptoms of myasthenia gravis progress over time.

Myasthenia gravis can affect any muscle on our body but there are certain muscles that are commonly affected than the others.

Eye muscles

Half of the people who are affected by this disease, this is their first symptom such as:

  • double vision (diplopia) that can be vertical or horizontal and improves when one eye is closed,
  • drooping of one or both eyelids (ptosis).

Face and throat muscle

With 15 percent of people with this disease, it can cause:

  • altered speaking like may be very soft or nasal;
  • difficulty swallowing, you are easily choked making it difficult to drink and eat;
  • problems chewing wherein the muscles that you are using while eating may wear out halfway through the meal;
  • limited facial expression, sometimes it can be very hard to smile.

Neck and limb muscles

It can cause weakness in your arms and legs, neck, sometimes along with your face, eyes and throat. If your neck is weak, you may have a hard time holding up your head or if your legs are weak, you may have a hard time walking or you may waddle.

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3 Causes

A breakdown in the normal communication between nerves and muscles is the cause of myasthenia gravis.

With this disease your immune system produces antibodies that destroy many of your muscles receptor sites for acetylcholine. Your muscles receive fewer nerve signals because there are fewer receptor sites available causing weakness. It may also block the function of a protein called tyrosine kinase that is involved in forming the nerve muscular junction that may lead to myasthenia gravis.

The thymus gland may trigger or maintain the production of the antibodies that block acetylcholine. Some people with myasthenia gravis have tumors of the thymus (thymomas) but mostly malignant or not cancerous. Some people have antibody-negative myasthenia gravis and lipoprotein-related protein 4 or antibodies against another protein.

Genetic factors, some mothers with myasthenia gravis have children who are born with myasthenia gravis (neonatal myasthenia gravis), if treated early will soon recover after two months of birth. Congenital myasthenis syndrome, a rare hereditary for of myasthenia.

Some of the factors that can worsen myasthenia gravis include:

  • medications such as beta blockers,
  • quinidine gluconate,
  • quinidine sulfate,
  • quinine (Qualaquin),
  • phenytoin (Dilantin),
  • some antibiotics and certain anesthetics,
  • illness,
  • fatigue,
  • extreme heat,
  • stress.

4 Making a Diagnosis

Making a diagnosis of myasthenia gravis is done by performing physical therapy and several tests.

When you visit your doctor, he may recommend you to a neurologist. Bring a notebook and write down all the symptoms that you are experiencing. Write down the list of supplements, medications that you are taking. You can ask your doctor some of these questions:

  • What is causing my symptoms?
  • What kind of tests do I need?
  • What treatments are available?
  • To they have side effects?
  • Are there restrictions I need to follow?
  • What websites do you recommend?
  • Are there any brochures I can take home with me?

Your doctor will likely ask you some questions such as:

  • When did you experience your symptoms?
  • Is it occasional or consistent?
  • How severe are they?

Tests for diagnosis include:

  • neurological examination: by testing your muscle strength, reflexes, senses of touch and sight, muscle tone, coordination balance,
  • edrophonium that will inject you with chemical edrophonium chloride (tensilon) that may result in temporary improvement of your muscle that might indicate you have myasthenia gravis,
  • ice pack test, your doctor will put a bag filled with ice on your eyelid then after 2 minutes he will remove it and analyze your eyelid for improvement,
  • blood test that may reveal the presence of abnormal antibodies that disrupt the receptor sites where nerve impulses will signal your muscle to move,
  • repetitive stimulation, the electrodes will be attached to your skin over the muscles to be tested then they will send electricity to measure the nerve’s ability to send a signal to your muscle,
  • single-fiber electromyography (EMG) that measures the electrical activity between your brain and muscle, they will insert a wire electrode through your skin into a muscle,
  • imaging scans such as MRI or CT scan to check for other abnormality in your thymus or to check for tumor,
  • pulmonary function test to check if your condition is affecting the way you breathe.

5 Treatment

Doctors will use a variety of treatments to relieve the symptoms of myasthenia gravis such as:

  • medications such a pyridostigmine (Mestinon) to enhance communication between muscles and nerves, this medication improve muscle contraction and muscle strength, side effects may include nausea, excessive salivation, sweating and gastrointestinal upset;
  • corticosteroids such as prednisone inhibit the immune system limiting antibody production, side effects are diabetes, weight gain, bone thinning and some infections;
  • immunosuppressant such as azathioprine (Imuran), mycophenolate mofetil (CellCept), cyclosporine (Sandimmune, Neoral) or tacrolimus (Prograf);
  • therapy plasmapheresis, this is similar to dialysis but beneficial effect lasts only a few weeks, side effects are drop in blood pressure, bleeding, muscle cramps and heart rhythm problems or may have allergic reaction to the solution used to replace the plasma;
  • Intravenous immunoglobulin (IVIg), a therapy that provides your body with normal antibodies that alters your immune system response and has lower side effects than the other therapy;
  • surgery, about 15 percent of people with myasthenia gravis have a tumor in their thymus gland under the breastbone, if you have a tumor called thymoma, you will have a surgery to remove your thymus gland to improve the symptoms of myasthenia gravis, it may also eliminate your symptoms and you can stop taking your medicines but you may only see the benefits of it after several years;
  • thymectomy is an open surgery that will split your central breastbone (sternum) to open your chest and remove your thymus gland which uses smaller incisions;
  • minimally invasive thymectomy may include: video assisted, the surgeon will make a small incision in your neck and use a ling thin camera(video endoscope) to remove the thymus gland and visualize it’ robot assisted thymectomy, several small incisions will be done in the side of the chest to remove the thymus gland with the use of robotic system that includes a camera arm and mechanical arms, this will make less pain, less blood loss and lower mortality.

Your doctors will check what type of treatment you need based on:

  • your age,
  • location of the muscle that is affected,
  • severity of your condition,
  • if you have other medical conditions.

6 Prevention

Myasthenia gravis cannot be prevented, but avoiding these triggers may help patients prevent the symptoms:

  • fever,
  • emotional stress,
  • illness (respiratory infection, pneumonia, tooth abscess),
  • exposure to extreme temperatures,
  • overexertion,
  • medications (muscle relaxants, anticonvulsants, certain antibiotics),
  • low levels of potassium in the blood (hypokalemia caused by diuretics, frequent vomiting).

7 Alternative and Homeopathic Remedies

Homeopathic remedies have been found effective in cases of myasthenia gravis such as:

  • Alumina,
  • Conium Gelsemium,
  • Zincum,
  • Sepia,
  • Niccolum,
  • Cabo-an,
  • Cadmium,
  • Cocc,
  • Psorinum,
  • Guare,
  • Graphites.

8 Lifestyle and Coping

Consider some of these tips to cope with the symptoms of myasthenia gravis:

  • adjust your eating routine,
  • take your time chewing and swallowing,
  • try to eat when you have a good muscle,
  • try eating soft food for a while; avoid hard foods that are hard to chew,
  • have small meals eaten several times a day,
  • keep your house clean,
  • you can install grab bars or railings so you will not fall and you will have support,
  • outside of your house keep paths and sidewalks clean and out of leaves or rocks so you will not stumble,
  • be careful as you might lose energy quick when doing tasks,
  • use electric appliances and power tools to help you,
  • wear eye patch if you have double vision, you can wear it while you are reading, watching or writing, switch it to the other eye to reduce eye strain,
  • reduce extra walking as you may feel tired fast; plan what you are going to do that day,
  • find ways to relax.

You can also ask a family member to help you with a task. If you have a friend or family member that has myasthenia gravis try to understand their situation.

Read and learn about myasthenia gravis.

Contact a support group in your area or you can talk to a counselor about your condition.

9 Risks and Complications

There are several risks and complications associated with myasthenia gravis.

Myasthenia gravis is a life threatening condition that occurs when the muscles that control breathing become too weak to do their jobs. There are medications and therapies to help people with myasthenia gravis to breathe on their own.

  • Thymus tumor, 15 percent of people with myasthenia gravis has this although some of these tumors (thymomas) are malignant;
  • an overactive thyroid that can cause weight loss and heat;
  • autoimmune conditions such as lupus and rheumatoid arthritis;
  • underactive or overactive thyroid gland that will make it difficult for you in dealing with cold and weight gain.
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