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Myasthenia gravis is characterized by weakening and fast tiredness of any of your voluntary muscles. A breakdown in the regular communication between neurons and muscles causes it.
Myasthenia gravis has no cure, but treatment can help improve symptoms such as arm or leg weakness, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing, and breathing.
Although this condition can affect persons of any age, it is more common in women under the age of 40 and males over the age of 60.
WHAT ARE THE SYMPTOMS OF MYASTHENIA GRAVIS?
Myasthenia gravis causes muscle weakness that develops as the affected muscle is engaged. Muscle weakness might come and go because symptoms normally improve with rest. However, the symptoms normally worsen with time, reaching their peak within a few years of the disease's inception.
Although myasthenia gravis can affect any of your voluntary muscles, certain muscle groups are more typically affected than others.
Eye muscles
More than half of persons who develop myasthenia gravis experience ocular issues as their initial signs and symptoms, such as:
Drooping of one or both eyelids (ptosis)
Double vision (diplopia), which improves or disappears when one eye is closed.
Face and throat muscles
The early signs of myasthenia gravis include the muscles of the face and throat, which can:
- Impair your speech: Depending on which muscles are affected, your speech may sound soft or nasal.
- Make swallowing tough: You may choke easily, making eating, drinking, and taking medicines difficult. In other circumstances, liquids that you are attempting to swallow escape through your nose.
- Affect chewing: Chewing muscles may tire midway through a meal, especially if you've been eating something difficult to chew, such as steak.
- Alter your facial expressions: For example, your smile could resemble a snarl.
Neck and limb muscles
Myasthenia gravis can also induce neck, arm, and limb weakness. Leg weakness might have an impact on how you walk. Weak neck muscles make it difficult to hold your head high.
WHEN SHOULD YOU SEE A DOCTOR?
Talk to your doctor if you have troubles:
- Breathing
- Chewing
- Walking
- Seeing
- Swallowing
- Making use of your arms or hands
- Keeping your head up
WHAT ARE THE CAUSES OF MYASTHENIA GRAVIS?
Antibodies
Nerves communicate with muscles by releasing chemicals (neurotransmitters) that bind to receptor sites on muscle cells at the nerve-muscle junction.
In myasthenia gravis, your immune system creates antibodies that block or destroy many of your muscles' acetylcholine receptor sites. Your muscles receive fewer nerve signals as there are fewer receptor sites accessible, resulting in weakness.
Antibodies can also inhibit the action of a protein known as muscle-specific receptor tyrosine kinase, or MuSK. This protein aids in the formation of the nerve-muscle junction. Antibodies to this protein can cause myasthenia gravis. Antibodies against another protein known as lipoprotein-related protein 4 (LRP4) may contribute to the onset of this illness. Other antibodies have been identified in research studies, and the number of antibodies implicated is likely to grow in the future. Myasthenia gravis can occur in people who do not have antibodies that inhibit acetylcholine, MuSK, or LRP4. Seronegative myasthenia gravis, also known as antibody-negative myasthenia gravis, is a form of myasthenia gravis. Researchers believe that certain kinds of myasthenia gravis still have an immunological origin, but that the antibodies implicated are not yet identifiable.
Thymus gland
The thymus gland is an immune system component located in the upper chest beneath the breastbone. The thymus gland, according to researchers, initiates or maintains the creation of antibodies that inhibit acetylcholine.
The thymus gland is large in childhood but modest in adults. However, in some adults with myasthenia gravis, the thymus gland is excessively big. Some persons with myasthenia gravis also have thymus gland tumors (thymomas). Thymomas are not usually carcinogenic (malignant), but they can develop into cancer.
Other causes
Mothers with myasthenia gravis rarely have children with myasthenia gravis (neonatal myasthenia gravis). Children usually recover within two months of birth if they are treated promptly.
Congenital myasthenic syndrome is a rare, inherited form of myasthenia gravis that affects some children at birth.
Factors that may aggravate myasthenia gravis
- Fatigue
- Infection or illness
- Surgery
- Stress
- Pregnancy
- Menstrual periods
- Some drugs, such as beta blockers, quinidine gluconate, quinidine sulfate, quinine (Qualaquin), phenytoin, certain anesthetics, and some antibiotics, can cause heart failure.
WHAT ARE THE COMPLICATIONS OF MYASTHENIA GRAVITIS?
Myasthenia gravis complications are curable, however some can be fatal.
Myasthenic crisis
Myasthenic crisis is a potentially fatal disorder that develops when the muscles that control breathing become ineffective. Emergency care and mechanical breathing assistance are required. Medications and blood-filtering therapy enable folks to breathe normally again.
Thymus gland tumors
Some persons with myasthenia gravis develop a tumor in the thymus gland, a gland behind the breastbone important in the immune system. The majority of these tumors, known as thymomas, are not cancerous (malignant).
Other disorders
Myasthenia gravis patients are more likely to have the following conditions:
- Underactive or overactive thyroid: The thyroid gland, located in the neck, produces hormones that regulate metabolism. If your thyroid is underactive, you may struggle with colds, weight gain, and other concerns. An overactive thyroid can create problems with heat, weight loss, and other complications.
- Autoimmune diseases: People with myasthenia gravis may be predisposed to autoimmune diseases such as rheumatoid arthritis or lupus.
HOW IS MYASTHENIA GRAVIS DIAGNOSED?
Your doctor will assess your symptoms and your medical history and do a physical examination. Your doctor may order the following tests:
Neurological examination
Your doctor may do the following tests to assess your neurological health:
- Reflexes
- Muscle strength
- Muscle tone
- Touch and sight senses
- Coordination
- Balance
The following tests may be used to confirm a diagnosis of myasthenia gravis:
Ice pack test
If you have a droopy eyelid, your doctor may place an ice bag on your eyelid. Your doctor removes the bag after two minutes and examines your droopy eyelid for evidence of improvement.
Blood analysis
A blood test could identify the existence of aberrant antibodies that interfere with the receptor sites where nerve impulses signal your muscles to move.
Repetitive nerve stimulation
Doctors apply electrodes to your skin over the muscles to be examined in this nerve conduction investigation. Doctors use short pulses of electricity to test the nerve's ability to convey a signal to your muscle.
Doctors will frequently test the nerve to check if its ability to convey impulses worsens with exhaustion in order to identify myasthenia gravis.
Single-fiber electromyography (EMG)
This test detects electrical activity between your brain and your muscles. A thin wire electrode is inserted through your skin and into a muscle to test a single muscle fiber.
Imaging
A CT scan or an MRI may be ordered by your doctor to determine the presence of a tumor or other abnormality in your thymus.
Pulmonary function tests
These tests determine whether your condition is interfering with your breathing.
WHAT ARE THE TREATMENTS FOR MYASTHENIA GRAVIS?
Various medications, either alone or in combination, can alleviate myasthenia gravis symptoms. Your therapy will be determined by your age, the severity of your disease, and the rate at which it progresses.
Medications
- Cholinesterase inhibitors: Medications such as pyridostigmine (Mestinon, Regonal) improve nerve-muscle communication. These drugs are not a cure, but they can help some people increase muscle contraction and strength.
GGI upset, diarrhea, nausea, and increased salivation and perspiration are all possible adverse effects.
- Corticosteroids: Prednisone (Rayos) and other corticosteroids suppress the immune system, decreasing antibody synthesis. However, long-term use of corticosteroids can cause major adverse effects such as bone loss, weight gain, diabetes, and an increased risk of certain infections.
- Immunosuppressants: Other medications that affect your immune system that your doctor may give include azathioprine (Azasan, Imuran), mycophenolate mofetil (Cellcept), cyclosporine (Sandimmune, Gengraf, and others), methotrexate (Trexall), and tacrolimus (Astrograf XL, Prograf, others). These medications, which can take months to work, may be taken in conjunction with corticosteroids.
Immunosuppressant side effects, such as an increased risk of infection and liver or kidney damage, can be severe.
Intravenous treatment
The following therapies are typically used in the short term to treat a rapid exacerbation of symptoms or as a preventative measure before surgery or other therapies.
- Plasmapheresis: This technique employs a filtering method similar to dialysis. Your blood is filtered through a machine that eliminates antibodies that obstruct signal transmission from nerve terminals to muscle receptor sites. However, the positive results usually only last a few weeks, and repeated surgeries can make it difficult to reach veins for therapy.
Plasmapheresis risks include a drop in blood pressure, hemorrhage, cardiac rhythm difficulties, and muscle cramping. Some people are allergic to the solutions used to replace the plasma.
- Intravenous immunoglobulin (IVIg): This therapy infuses your body with normal antibodies, altering your immune system's response. Benefits are usually noticeable after a week and can last for 3 to 6 weeks.
Chills, dizziness, headaches, and fluid retention are some of the most common side effects.
- Monoclonal antibody: Intravenous medicines for myasthenia gravis include rituximab (Rituxan) and the recently approved eculizumab (Soliris). These medications are typically prescribed to patients who have not responded to prior treatments. They can have significant consequences.
Surgery
Some persons with myasthenia gravis develop a thymus gland tumor. If you have a tumor called a thymoma, your thymus gland will be surgically removed (thymectomy).
Even if you do not have a tumor in your thymus gland, eliminating it may help your myasthenia gravis symptoms. However, the advantages of thymectomy can take years to manifest.
A thymectomy can be performed either openly or less invasively. Your surgeon will split the center breastbone (sternum) to open your chest and remove your thymus gland during open surgery.
Smaller incisions are used in minimally invasive surgery to remove the thymus gland. It could also include:
- Video-assisted thymectomy: Surgeons create a small incision in your neck or a few small incisions on the side of your chest in one type of this procedure. The thymus gland is then examined and removed using a long, thin camera (video endoscope) and small equipment.
- Robot-assisted thymectomy: In this type of thymectomy, surgeons make numerous small incisions in the side of your chest and use a robotic system that comprises a camera arm and mechanical arms to remove the thymus gland.
When compared to open surgery, these methods may result in less blood loss, less pain, lower fatality rates, and shorter hospital stays.
HOME REMEDIES FOR MYASTHENIA GRAVIS
To help you make the most of your energy and manage with myasthenia gravis symptoms:
- Change your dietary habits: Try to eat while your muscles are strong. Take your time chewing your food and give yourself a break between bites. It may be easier for you to consume small meals multiple times a day. Additionally, aim to eat mostly soft foods and avoid things that need more chewing, such as raw fruits and vegetables.
- Take safety precautions at home: Install grab bars or railings in areas where you need assistance, such as near to a bathtub or steps. Keep your floors clean and area rugs moved. Keep paths, sidewalks, and driveways clean of leaves, snow, and other debris that could cause you to trip.
- Put on an eye patch: If you suffer from double vision, an eye patch can assist. Wear one while writing, reading, or watching television. To assist reduce eyestrain, move the eye patch to the opposite eye on a regular basis.
- Plan: If you have chores, shopping, or errands to go, schedule them when you have the most energy.
- Use power tools and electric appliances: Try utilizing an electric toothbrush, electric can openers, and other electrical items to help you maintain your energy levels.