Myasthenia Gravis
Myasthenia Gravis (MG) is an autoimmune condition that causes signal transmission issues at the neuromuscular junction. As a result, the muscles get fatigue fast and improve after taking rest.
It mostly affects the muscles that regulate eye movements, facial expressions, chewing, and swallowing in the early stages. As the condition worsens, the neck and limb muscles may be affected, making it difficult to hold the head up, walk upstairs, and raise the arms. Breathlessness may occur if left untreated.
Although this condition does not run in families, those who develop autoimmune conditions are more likely to develop myasthenia gravis.
Types
The following are the types of myasthenia gravis:
- Ocular myasthenia gravis
- Juvenile myasthenia gravis
- Congenital myasthenia gravis
- Transient neonatal myasthenia gravis
- Generalized myasthenia gravis
Symptoms
Initially patients may notice drooping of eyelids and impaired or double vision. Patients may present with difficulty in swallowing and chewing . Generalised weakness usually develops in first 2 years of illness. Myasthenia gravis symptoms, in general, include:
- Trouble holding up your head
- Drooping eyelids
- Eye muscles weakness
- Change in your facial expression
- Double vision
- Shortness of breath
- Trouble swallowing
- Problems walking and lifting things
- Speech problems
In severe MG conditions the respiratory muscles become so weak that one can't control them. This is a medical emergency that requires the use of a ventilator to assist patients in breathing. Around 15% to 20% of people with myasthenia gravis will have at least one myasthenic crisis. It can be caused by an infection, stress, surgery, or a medical reaction.
When to see a doctor?
If you experience drooping of eyelids ,double vision or chewing difficulty which worsens by evening , it could be a symptom of myasthenia so consult a neurologist or a rheumatologist.
Causes
Myasthenia gravis is not hereditary or contagious. It usually appears later in life when antibodies in the body assault normal muscle receptors. This inhibits a hormone that is required to induce muscular contraction. When a mother with myasthenia gravis transfers the antibodies to the baby, a short form of myasthenia gravis might emerge. It usually resolves itself in 2 to 3 months.
Risk Factors
Muscular dystrophy is a hereditary disease. A family history of muscular dystrophy puts you at risk of being a carrier or getting the disease.
- Smoking and tobacco chewing
- Physical inactivity
- Obesity
- Insufficient diet including lower rate of fish consumption.
Complications
Myasthenia gravis complications are curable; however, some can be fatal.
Myasthenic crisis
Myasthenic crisis occurs when the respiratory muscles that control breathing become too weak to function. Emergency care and mechanical breathing support are required. Medications and blood-filtering therapy or Immunoglobulin therapy enable people to breathe normally again.
Thymus gland tumours
Some patients with myasthenia gravis develop thymus gland tumours, a gland beneath the breastbone linked with the immune system. Most of these tumours, known as thymomas, are not cancerous (malignant).
Other disorders
Myasthenia gravis patients are more likely to have the following conditions
Autoimmune conditions
Myasthenia gravis patients may be prone to autoimmune diseases such as rheumatoid arthritis or lupus.
Underactive or overactive thyroid
The thyroid gland, which is located in the neck, secretes hormones that control metabolism. If the thyroid is underactive (hypothyroidism), people may struggle with colds, weight gain, and other concerns. An overactive thyroid (hyperthyroidism) can create problems with heat, weight loss, and other complications.
Prevention
It is difficult to avoid MG; however, people can take steps to stop a flare-up of symptoms or prevent consequences from developing. These include practising good hygiene to avoid infections and promptly treating them if they develop. It is a good idea to avoid extreme heat and overexertion. Effective stress management can also lower the frequency and severity of symptoms.
Diagnosis
Myasthenia gravis can be diagnosed based on the symptoms and certain tests. The doctor will inquire about the medical history and symptoms throughout the physical examination.
Edrophonium test
The doctor will give an injection of edrophonium chloride to see if it improves muscle strength. If it happens, it might be an indication of myasthenia gravis.
Ice pack test
If you have a drooping eyelid, the doctor may place an ice pack on it for 2 minutes to examine if the cold sensation affects it.
Blood test:
Routine blood tests to rule out other causes. Achr and musk autoantibodies are to be tested.
Repetitive nerve stimulation
This test sends small electrical pulses through electrodes into the muscles to examine if your nerves respond to the impulses.
Imaging test
Pulmonary functioning tests:
The doctor will examine the breathing ability to check if myasthenia gravis has affected the lungs.
Treatment
MG is a treatable condition; with treatment, many patients may live normal lives. Treatment options include
Medicines
Anticholinesterase medications, steroids, or medications that may be used to suppress the immune system's reaction (immunosuppressive).
Thymectomy
The thymus gland is surgically removed in all patients with myasthenia who has hyperplasia or neoplasm of thymus.
Plasmapheresis
A technique in which abnormal antibodies are removed from the blood and replaced with normal antibodies from donor blood.
Immunoglobulin
It is a blood product that helps to reduce the immune system's attack on the neurological system. It is administered intravenously (IV).
Both are useful in patients who are in myasthenia crisis
Dos and Don’ts
Most of the medications will have an effect on nerve muscle junction and can worsen myasthenia ,so consult a Neurophysician before starting any new medications.
The key to managing this condition is early diagnosis. The goal of treatment is to improve overall muscular function while preventing swallowing and breathing problems. Most patients with myasthenia gravis can restore their muscle functions and live normal or near-normal lives.
| Do’s | Don’ts |
| Adopt a positive attitude and remain cheerful | Get exposed to extreme heat |
| Maintain good hygiene | Eat dry and hard foods that can easily crumble and get stuck into the windpipe. |
| Make regular visits to your doctor | Drink alcohol and smoke |
| Take adequate rest. | Drink less water |
| Avoid stress | Lead a sedentary lifestyle |
These dos and don'ts can assist people manage the condition by avoiding and reducing its negative effects. Make and keep regular follow-up appointments with the doctor to keep track of the symptoms and to control the severity of the disease.
Myasthenia Gravis Care at Medicover Hospitals
At Medicover hospitals, we have the best team of rheumatologists and neurologists who work together to provide myasthenia gravis treatment with utmost precision. Our highly skilled team utilises the latest medical equipment, diagnostic procedures and technologies to treat various autoimmune diseases and ailments. For myasthenia gravis, we adopt a multi-disciplinary approach to provide comprehensive care to the patients and attend to all their medical needs for faster and sustained recovery.
