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What is myasthenia gravis? -

Myasthenia gravis (MG) is an autoimmune disease condition that affects the communication between nerves and muscles, also known as the neuromuscular junction.

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How does it manifest? -

People who suffer from MG lose voluntary control of their muscles and also experience muscle fatigue and weakness. Some people lose the ability to move muscles in the face, eyes, neck, and limbs.

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Is there a cure? -

There isn’t a cure as such for this neuromuscular disease, but treatments can help manage the condition, and some people may achieve remission.

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How common is it? -

It is estimated that MG affects around 20 out of every 100,000 people. Some 36,000 to 60,000 suffer from the condition in the US alone. But statistics may not be accurate because mild cases may never be diagnosed.

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Who’s at risk? -

While the condition can affect people of all ages, women aged 20 to 40 and men aged 50 to 80 are most at risk. While cases exist, it’s less prominent in teenagers, and rare in children.

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Risk factors -

There are a number of risk factors when it comes to developing MG. These include a history of other autoimmune diseases (e.g. rheumatoid arthritis, lupus, etc.) and thyroid disease.

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Risk factors -

Risk increases for those taking medications for malaria, cancer, or heart arrhythmias. People who have undergone surgical procedures are also more at risk.

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Types of myasthenia gravis: ocular -

One of the most common forms of autoimmune MG is ocular. This is when the muscles that move the eyes and eyelids are affected and become weakened. People with ocular MG may struggle to keep their eyes open, the eyelids may droop, or vision may be compromised.

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Types of myasthenia gravis: generalized -

This is when the muscle weakness caused by MG starts to affect other areas, including the face, neck, and limbs. Patients may struggle to speak or swallow, lift their arms over their heads, stand up from a chair, climb stairs, or walk longer distances.

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What causes myasthenia gravis? -

Like other autoimmune conditions, the causes of myasthenia gravis are unknown.

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How the immune system attacks itself in MG patients -

People who suffer from MG produce antibodies that destroy the nerve receptors in muscle tissue and therefore block normal nerve-muscle communication.

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Symptoms -

Initially, muscles start to get weaker during activity, regaining their strength after some rest. But MG can also trigger other symptoms.

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Symptoms -

Other symptoms include double vision, drooping eyelids (ptosis), difficulty in walking, speaking, chewing, and swallowing.

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Symptoms -

People with MG can also struggle with neck movement, including holding up their head. Limb weakness is also a commonly reported symptom among sufferers.

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Diagnosis: ice pack test -

If patients demonstrate signs of drooping eyelids, then an ice pack test is usually prescribed. The test has patients resting in a dark room with ice packs on their eyes. The drooping is supposed to improve after a few minutes. If not, the patient might have MG.

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Diagnosis: antibody tests -

Being an autoimmune disease, the vast majority of patients have high levels of antibodies in their blood, being the most common acetylcholine receptor antibodies. Some also have muscle-specific kinase (MuSK) antibodies.

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Diagnosis: scans -

Imaging tests such as a CT scan or MRI may be done to rule out any thymus gland problems such as tumors.

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Diagnosis: electromyogram -

An EMG also can help detect any communication issues between nerves and muscles.

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Treatment: medications -

MG patients have at their disposal a variety of treatments that can help manage the symptoms. These include certain medications, such as cholinesterase inhibitors (anticholinesterase), which boost signals between nerves and muscles and therefore improve muscle strength.

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Treatment: medications -

Immunosuppressants, including corticosteroids, are used to curb the excessive production of antibodies and decrease inflammation.

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Treatment: monoclonal antibodies -

Biologically engineered proteins may be administered via IV to help suppress the patient’s overactive immune system.

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Treatment: IV immunoglobulin -

IV infusions of donor antibodies can also be given to patients as a treatment for myasthenia gravis.

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Treatment: plasma exchange -

Plasma exchange (or plasmapheresis) is used to remove abnormal antibodies from a patient’s body via an IV line.

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Treatment: surgery -

Surgery to remove the thymus gland (called a thymectomy) is sometimes performed, and usually has a positive impact on symptoms.

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How to live with MG -

Avoid the heat, as it can worsen muscle fatigue. As such, try to avoid going out on a hot day when temperatures are at their peak. Cold compresses on the head and neck may also help.

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How to live with MG -

Exercise is a great way to gain strength as well as increase energy levels.

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How to live with MG -

Make sure you manage physically demanding tasks throughout the day and include rest periods (and even naps) if and when necessary.

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How to live with MG -

A healthy diet, with an adequate intake of macronutrients (protein, carbs, fat) and micronutrients (vitamins and minerals) will also help.

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Outlook -

With adequate treatment, most people with MG are able to enjoy a good quality of life.  

Sources: (Cleveland Clinic) (Mayo Clinic) (NHS)

See also: The risks of developing metabolic syndrome

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