Myasthenia Gravis Symptoms | Causes
of Myasthenia Gravis | Myasthenia Gravis
Treatment | Myasthenia Gravis Cure | Myasthenia
Myasthenia Gravis is a disease which should be considered anytime someone
is suffering from muscle weakness of severe muscle fatigue. The symptoms can be quite varied ranging from eye drooping or double vision all the
way to severe weakness of breathing muscle which would necessitate the
use of a breathing machine or ventilator in order to survive. The diagnosis
of myasthenia can often be very difficult and should be done by a neurologist
with expertise in disease of the nerve and muscle. We at Phoenix Neurological
Associates have cared for patients with mysthenia for over 25 years.
Being sure that the diagnosis is correct is extremely important in myasthenia
since it is always a treatable disease but the drugs used to treat myasthenia
frequently have unwanted side effects. Therefore before beginning therapy
one should be certain of the diagnosis
Myasthenia Gravis Symptoms
Myasthenia gravis is a disorder causing weakness and fatigue of voluntary
muscles. This weakness fluctuates, with symptoms usually being less severe
in the morning and then becoming worse later in the day.
involves muscles closest to the torso such as shoulders and hips. This
causes problems going up stairs and reaching above one’s head. It also
frequently involves the muscles of the eyes. In some cases only the muscles
of the eyes are affected which causes double vision and drooping eyelids.
It does not affect the muscles of the heart, gut, or bladder. However
the muscles of the mouth and throat can be involved which can cause severe
weakness of swallowing. In severe cases the disease can involve the muscles
of the diaphragm and respiratory muscles. This can lead to a patient
being unable to breath without the support of a mechanical ventilator.
This severe presentation of myasthenia is called a myasthenic crisis.
The weakness can develop over weeks to months; however, only a minority
of patients go on to have a myasthenic crisis.
Myasthenia Gravis Cause
Myasthenia Gravis is caused by a breakdown in the communication between
nerves and muscles, usually because of an immunological problem. When
the nerve sends signals to the muscles to contract a chemical called
acetylcholine is released by the nerves. This chemical binds to a specific
receptor on the muscle fibers called the acetylcholine receptor. In
Myasthenia Gravis a person begins making antibodies against the acetylcholine
receptor which destroys these receptors. Therefore the signals to move
travel down the nerve but the muscle cannot respond to the acetylcholine.
Rare cases of myasthenia gravis can begin in childhood or even in newborns
and in these cases there is an inherited defect in part of the acetylcholine
release by the nerve and the binding and response at the acetylcholine
In some cases Myasthenia Gravis can be associated with disorders
of other glands including the thymus and the thyroid. All patients diagnosed
with myasthenia should have tests done to look at the function of these
The disease should be suspected in anyone with muscle weakness,
particularly if there is drooping of the eyes or double vision. The disease
is diagnosed by doing blood tests to look for antibodies against the
acetylcholine receptor. A new antibody has been discovered as well called
the MUSK antibody, which causes a disease identical to Myasthenia Gravis.
EMG/NCS can also be performed to help confirm the diagnosis.
Myasthenia Gravis Treatment
The treatments of this disease focus on altering one’s immune system
so that fewer antibodies are produced and therefore the muscle can rebuild
its acetylcholine receptors. Perhaps the most commonly used initial
medication is prednisone. In addition many patients will take a medication
called mestinon. Mestinon allows the remaining acetylcholine receptor
a better chance to react to the acetylcholine released by the muscles.
This does not treat the underlying problem but can markedly improve the
Myasthenia Gravis symptoms. If prednisone does not completely resolve
the muscle weakness then a variety of other drugs are used in Myasthenia
Gravis treatments. Cellcept, azathioprine, cyclosporine, and intravenous
immunoglobulin all have a marked chance of improving one’s disease. If
patients experience a myasthenic crisis and are having difficulty swallowing
or breathing, then there is a procedure called plasmaphresis which is
very effective in improving one’s weakness. This is a procedure similar
to dialysis in which a patient’s blood is removed and washed of their
antibodies and then returned to the patient. This is usually repeated
five times over a 7-10 day period and is very effective.
with Myasthenia respond differently to different drugs and so the important
point is to follow with a neurologist closely who can adjust medications
as the symptoms dictate.
Myasthenia Gravis Cure
Most patients who develop myasthenia will keep the disease for the remainder
of their life. There are numerous research trials and basic science research
looking at how to reset the immune system and achieve a cure. In some
patients if there are abnormalities of the thymus gland, then removal
of this gland surgically has been associated with a chance of disease
Myasthenia Gravis Research
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