Myasthenia gravis – is chronic autoimmune neuromuscular disorder , the condition which affects the voluntary muscles of the body.
In this condition, the immune system mistakenly targets and attacks the receptors
Which is responsible for receiving signals from nerve cells at the neuromuscular junction—the point where nerve cells connect with muscles.
The antibodies produced by the immune system bind to these receptors and impair their function, leading to muscle weakness and fatigue.
The muscles most commonly affected by myasthenia gravis –
include those which are controlling the eye movements, facial expressions, chewing, swallowing, and speaking.
However, it can also affect other muscles in the body, such as those involved in breathing and limb movements.
The onset of myasthenia gravis can occur at any age, but it is more commonly diagnose in young adult women and older men.
The exact cause of this condition is not known, but it is believed to involve a combination of genetic and environmental factors.
Symptoms of Myasthenia Gravis
Symptoms of myasthenia gravis may vary among individuals but often include:
- Muscle weakness: The hallmark symptom, which worsens with activity and improves with rest. Weakness may fluctuate throughout the day.
- Fatigue: Muscles tire easily, making it difficult to sustain activity for extended periods.
- Double vision (diplopia) and drooping eyelids (ptosis): These occur due to weakness in the eye muscles.
- Difficulty swallowing (dysphagia) and chewing: Weakness in the muscles involved in swallowing and chewing can lead to choking or aspiration.
- Weakness in facial muscles: This can cause problems with speaking, smiling, or facial expressions.
- Weakness in limb muscles: It may become challenging to lift objects or perform fine motor tasks.
Myasthenia gravis Diagnosis
The diagnosis of involves several steps
It is typically perform by a healthcare professional specializing in neurology or neuromuscular disorders.
The process may include the following:
Medical history and physical examination:
Your Qualified doctor will review your medical history, ask you about any symptoms which you are experiencing.
They will also conduct a thorough physical examination to assess muscle strength, reflexes and any specific signs related to myasthenia gravis.
such as drooping eyelids or double vision.
Neurological examination:
A neurological examination wii be perform to evaluate the function of your nervous system
including testing reflexes, coordination, and sensory responses.
Blood tests:
Blood tests may be conduct to check for specific antibodies associated with myasthenia gravis.
The presence of these antibodies, such as anti-acetylcholine receptor antibodies (AChR) or anti-muscle-specific kinase antibodies (MuSK).
Which can provide supportive evidence for the diagnosis.
Electromyography (EMG):
EMG is the test which measures the electrical activity of muscle fibers.
It can help assess the function of the nerves that control the muscles
It may reveal abnormalities in the neuromuscular junction that are characteristic of myasthenia gravis.
Edrophonium test:
This is a diagnostic test that involves the injection of a medication called edrophonium chloride (Tensilon)
monitoring its effects on muscle weakness. Improvement in muscle strength following the injection is suggestive of myasthenia gravis.
Imaging studies:
In some cases, imaging studies such as a chest CT scan may be ordered to look for tumors of the thymus gland, as these can be associated with myasthenia gravis.
Repetitive nerve stimulation:
This test involves applying repetitive electrical stimulation to a nerve and measuring the muscle’s response.
In myasthenia gravis, there is typically a characteristic decrease in the muscle’s response over time.
Diagnosing myasthenia gravis can be challenging due to its variable presentation and similarity to other neuromuscular conditions.
Your healthcare professional will consider the results of these tests, along with your symptoms and clinical examination findings, to make an accurate diagnosis.
It is important to consult with a healthcare professional for a comprehensive evaluation and appropriate diagnosis of myasthenia gravis.
Myasthenia Gravis treatment
The treatment of myasthenia gravis typically involves a combination of medications, thymectomy (surgical removal of the thymus gland) and supportive therapies.
The specific treatment approach may vary depending on the severity of symptoms, the individual’s response to medications, and other factors.
It is important to work closely with a healthcare professional specializing in neuromuscular disorders to develop an individualized treatment plan.
Here are the main treatment options for myasthenia gravis:
Medications:
Acetylcholinesterase inhibitors:
Medications like pyridostigmine (Mestinon) are commonly prescribed to improve neuromuscular transmission and temporarily relieve muscle weakness.
They inhibit the enzyme that breaks down acetylcholine, a neurotransmitter involved in muscle contraction.
Immunosuppressants:
Medications such as prednisone, azathioprine, mycophenolate mofetil and tacrolimus may be used to suppress the immune system’s response
And decrease the production of antibodies which attack the neuromuscular junction.
Immunomodulating therapies:
Intravenous immunoglobulin (IVIG) or plasmapheresis (plasma exchange)
may be employed in severe cases or as a short-term treatment to rapidly improve muscle strength by modifying the immune response.
Thymectomy:
If a thymoma (a tumor of the thymus gland) is present or if the thymus is hyperplastic (overgrown), surgical removal of the thymus gland (thymectomy) may be recommended.
Thymectomy can reduce disease severity and the need for long-term immunosuppressive medications.
Supportive Therapies:
Physiotherapy:
Physiotherapy plays a vital role in managing myasthenia gravis by improving muscle strength, optimizing functional abilities and providing strategies for energy conservation.
Occupational therapy:
Occupational therapists can help individuals adapt to daily activities, provide strategies for conserving energy and recommend assistive devices to maintain independence and improve quality of life.
Speech therapy:
If myasthenia gravis affects the muscles involved in speaking and swallowing, speech therapists can assist with exercises, techniques, and strategies to improve speech clarity and swallowing function.
Monitoring and Adjusting Medications:
Regular monitoring of symptoms and medication effectiveness is crucial in myasthenia gravis.
Medications may need to be adjusted over time to manage symptoms effectively while minimizing side effects.
Lifestyle and Self-care:
Managing stress, maintaining a balanced diet, getting adequate rest, and avoiding factors that can worsen symptoms .
such as certain medications that interfere with neuromuscular transmission can contribute to overall well-being and symptom management.
It is important to note that the treatment approach for myasthenia gravis should be individualized.
The Treatment results may vary among individuals.
Multidesciplinary approach with healthcare professionals required including neurologists, rheumatologists and specialized neuromuscular teams , like Physiotherapist , occupational therapist & speech therapist.
It is essential to develop an optimal treatment plan and ensure ongoing care and support.
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