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Myasthenia Gravis (MG) is classified as a chronic disease. It affects how nerves and muscles talk to each other, leading to muscle weakness. While the condition is rare, it can change life for those who have it.
Myasthenia gravis occurs due to the physical invasion of muscles by the immune system. Weak eye muscles are often the first symptoms.
Other muscles, such as the jaw and limbs, can also become weak. Most importantly, the muscles that help in breathing get affected. While there isn't any cure at the moment, there are treatments that can manage the condition.
Symptoms of Myasthenia Gravis
Myasthenia Gravis comes with some sneaky symptoms. The big one? Muscle weakness, which gets worse as the day drags on. If you’re working those muscles a lot, you’ll definitely feel it.
The eyelids usually give the first clue with a case of “tired eyes” or blurry, double vision (diplopia). Some people with MG only deal with weak eye muscles, but others aren't so fortunate. The condition can spread, making more muscles feel like they’ve taken an unexpected vacation.
Beyond the eyes, other symptoms include:
●Weak jaws leading to sloppy chewing, choking on food, or talking like you’ve just had dental work.
●A limited range of facial expressions
●Weakness in arms, hands, legs, or even the neck.
Remember, MG weakness is different from general tiredness. In this case, the muscles barely move, even if you want them to.
Rarely, things get serious with a myasthenic crisis. This life-threatening situation makes breathing difficult, thanks to extremely weak respiratory muscles. A change in medications, infections, or surgery can trigger it. When that happens, intubation and a trip to the ICU are in order.
Causes of Myasthenia Gravis
Myasthenia gravis (MG) is a disorder that can be classified as autoimmune. The body’s defense systems attack the muscles by mistake.
More often than not, these antibodies will be directed towards acetylcholine receptors (AChR). Acetylcholine helps muscles contract. When AChR is blocked or destroyed, muscle weakness happens.
In some cases, the immune system targets a different protein. For example, it attacks muscle-specific receptor tyrosine kinase (MuSK). MuSK is critical for targeting and clustering acetylcholine receptors. Without MuSK, muscle signals get mixed up, causing weakness.
Attacks on both AChR and MuSK are attributed to muscle weakness. The exact process may be a little different. Other antibodies, like LRP4, may also have a role to play. Why this happens is not fully known. It might be due to genes, the environment, or infections.
Diagnosis of Myasthenia Gravis
The initial steps of myasthenia gravis diagnosis include a medical history and exam. A neurologist often does these tests. During this step, they often inquire about the current signs and symptoms. You may be asked about difficulties with speaking or swallowing.
They will also ask if you have muscle weakness elsewhere, like in your arms or legs. They may check if your weakness is worse in the morning or evening.
After this, they proceed with a neurological evaluation. This checks your muscle strength and tone. They will also look at your eye movements.
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Blood tests can confirm myasthenia gravis. The acetylcholine receptor antibody test is the most accurate. It checks for abnormal antibodies. They may also look for MuSK antibodies.
Electrophysiological studies are another option. These include repetitive nerve stimulation and single-fiber EMG. These tests help when other results are unclear.
The edrophonium test used to be common but is less available now. It involved injecting a medicine to see if muscle strength improved. If it did, the test was positive.
Imaging tests like CT or MRI can check for thymus gland tumors. Sometimes, doctors also order an MRI of the brain. This helps rule out other conditions, like stroke or brain tumors.
Treatment options for Myasthenia Gravis
Currently, there is no known treatment for myasthenia gravis. However, the various treatments available are able to relieve the symptoms and control the disease itself.
●Acetylcholine Inhibitors
These medications prevent acetylcholine from being metabolized. That improves the performance of the muscles. The most important medicine is Meztinon (pyridostigmine). Side effects comprise diarrhea, cramps, and nausea. Taking it with food helps.
●Immunosuppressants
These medications decrease the immune system's response to attack. Prednisone is one such medication. Drugs like Imuran, CellCept, or Prograf are used. These medications need careful monitoring. Side effects can be serious. Some side effects can be very dangerous.
●Plasmapheresis
This treatment removes harmful antibodies from the blood. Fresh plasma is put back in. It helps in a crisis but doesn’t last long. It can cause low blood pressure and cramps. It is costly.
●Intravenous immunoglobulin (IVIG)
IVIG is the infusion of antibodies from healthy individuals. It lasts over a course of several days. IVIG is effective in emergencies but is used up quite fast. They come with some side effects, including diseases of the kidney.
●Thymectomy
Surgery to remove the thymus gland can help. It may even cure symptoms. It’s a must if there’s a tumor. Talk to a doctor to see if surgery is right for you.
Coping with the disease
Managing myasthenia gravis can feel like walking a tightrope. Avoiding missteps is key. Emotional stress is a big no-no. Keep stress levels low. Surgery, pregnancy, and thyroid issues can also cause problems. Watch out for these.
High temperatures can worsen symptoms. This includes fever or overheating. Be cautious with certain medications.
Antibiotics like Cipro, beta-blockers like Inderal, and drugs like lithium, magnesium, and verapamil can trigger attacks. Stay alert with new medications and watch for signs of muscle weakness.
Infections like the flu or pneumonia can lead to flare-ups. Keep up with vaccines, including the annual flu shot. This helps keep illness at bay and reduces complications.
As mentioned before, myasthenia gravis is a chronic autoimmune disorder that disrupts muscle function through misguided immune responses.
While a cure is still playing hard to get, there are plenty of treatments to keep the symptoms in check and make life a bit easier. The trick to managing it? Dodge those triggers, handle medications with care, and stay sharp on the infection front.
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