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Myasthenia Gravis: Symptoms, Treatment, And Causes

Myasthenia Gravis

Myasthenia Gravis - (Image Credit: Shutterstock)

30-Second-Summary
  • Myasthenia Gravis is an autoimmune disease that weakens the connections between nerves and muscles.
  • Fortunately, most people with myasthenia gravis are only mildly affected and have few if any problems.
  • MG can affect absolutely anyone but is most common among older adults. It affects approximately 1 in 100 of those over 60 and about 1 in 10,000 people under the age of 20.
  • There is no one specific cause of myasthenia gravis. Still, there is a combination of factors that contribute to the condition.
  • Unfortunately, there is no pinpoint way to know how your symptoms will affect you or another person.

Introduction

Myasthenia Gravis is an autoimmune disease that may weaken the connections between nerves and muscles. These weakened connections result in weakness of the muscles, especially with exertion.

The symptoms of myasthenia gravis can be subtle at first:

  • Double vision
  • Eyelid drooping
  • Trouble swallowing
  • Feeling like something flies into your eyes when you look up or down quickly.

MG can affect individuals of any age or gender, but it is more common in women in their childbearing years. Fortunately, most people with myasthenia gravis are only mildly affected and have few if any problems.

Those with more severe symptoms can often be treated effectively and lead everyday lives. However, there is no cure for Myasthenia Gravis just yet.

Myasthenia Gravis is an autoimmune condition that is characterized by weakness and the fatigability of skeletal muscles. It is also called “dying-back” disease because of the degeneration of the motor end-plates and the resulting weakness. MG may involve individuals of any age or gender, but it is more common in women in their childbearing years.

The most common symptoms of MG are:

  • Drooping eyelids (ptosis)
  • Double vision (diplopia)
  • Muscle weakness.

Most people with MG are treated with medications that suppress the immune system (i.e., immunosuppressive drugs). Here’s everything you may need to know about its causes and treatment as a patient.

How Common Is Myasthenia Gravis?

Myasthenia Gravis Formation
Myasthenia Gravis (MG) is the most common form of neuromuscular disease. It affects one to two people per 100,000 people. MG could affect absolutely anyone but is most common among older adults.

It affects approximately 1 in 100 of those over 60 and about 1 in 10,000 people under the age of 20. MG commonly affects women, but it can affect men too. People with MG have an immune system problem that makes their muscles weak and causes them to stop working correctly.

There are different types of myasthenia gravis. About 10 percent of those who have the disorder have the form called Lambert-Eaton myasthenic syndrome. In this type, the nerve cells that control muscle movement are damaged. Another type, called ocular myasthenia gravis, affects only the eyes. It may cause blurry vision or increased sensitivity to light and glare.

Myasthenia Gravis can also cause muscle pain across the face, neck, and chest. Other symptoms include fatigue and difficulty swallowing or speaking clearly.

Who Might Suffer From Myasthenia Gravis?

Myasthenia Gravis is an incredibly rare autoimmune disorder that may cause weakness of skeletal muscles. The cause is both a deficiency of the acetylcholine receptor at neuromuscular junctions and the destruction of these receptors by antibodies.

Myasthenia Gravis occurs more often in women than men and typically manifests between 20 and 60. However, it might happen at any age.

Some general risk factors may increase your chances of getting myasthenia gravis, including:

  • Being female
  • Being a smoker
  • Being exposed to toxic chemicals or drugs
  • Having certain blood disorders or liver conditions
  • Having underlying health conditions such as diabetes or lupus.

The symptoms of MG vary widely from person to person. Still, they usually include fatigue, muscle spasms, difficulty swallowing, and slurred speech. Because myasthenia gravis is an autoimmune disease, it may also lead to developing other conditions[1] such as thyroiditis and autoimmune inflammatory bowel disease.

Other causes include autoimmune conditions such as:

  • Sjögren’s syndrome
  • Multiple sclerosis
  • Lupus
  • Guillain-Barré Syndrome
  • Syphilis.

Sometimes, myasthenia gravis may be caused by several viruses at once. It can also occur in people who have had general anesthesia or surgery.

However, there is no known cure for myasthenia gravis, and most people will eventually experience symptom relief, although the course of the disease varies greatly from person to person.

What Are The Main Types Of Myasthenia Gravis?

Types Of Myasthenia Gravis
Myasthenia Gravis is a debilitating neuromuscular condition that can cause muscle weakness. There are three main types of myasthenia gravis: Systemic, Lambert-Eaton myasthenia, and autoimmune myasthenia gravis (AMG)

1. Systemic Myasthenia Gravis

Systemic myasthenia gravis involves damage to the nerves that transmit messages from the brain to the muscles throughout the body. Systemic myasthenia is an autoimmune neuromuscular disease that causes muscle weakness and fatigue. It is caused by antibodies in the blood that attack the body’s nerves causing damage to the muscles.

These antibodies make the immune system believe it’s fighting a virus or bacteria when it’s just attacking its nerves. The most common form of systemic myasthenia is primary myasthenia gravis, an autoimmune disease of the muscles.

2. Lambert-Eaton Myasthenia

Lambert-Eaton Myasthenia (LEM) is an autoimmune disease that causes weakness and muscle fatigue. LEM occurs in people of all ages, but it’s most common in middle-aged women. It is caused by antibodies that attack the electrical system in the body, causing weakness and fatigue. In most cases, the symptoms develop very gradually over time. They can include muscle weakness, numbness, difficulty with daily tasks, and a tingling sensation.

LEM affects the whole nervous system and may cause your muscles to weaken. The actual cause of LEM isn’t clear, however:

  • Genetics
  • Environmental factors, or
  • Viruses

It may play a role in triggering the condition. LEM can also be triggered by certain medications or infections.

LEM isn’t typically life-threatening, but it can be uncomfortable and worsen over time if left untreated. You may need to have some medicine to relieve symptoms or seek treatment for underlying medical conditions such as heart disease or diabetes.

3. Autoimmune Myasthenia

One other type of myasthenia gravis, known as autoimmune myasthenia gravis (AMG), occurs when antibodies from the immune system attack the acetylcholine receptor in the motor end-plates of skeletal muscle fibers, resulting in weakness.

Autoimmune myasthenia gravis is relatively rare; about 0.06% of people with neuromuscular disorders show AMG symptoms, and most cases occur in patients over age 70.

Symptoms may include:

  • Difficulty swallowing, speaking or breathing due to paralysis of facial muscles.
  • Numbness or tingling in arms and legs.
  • Slurred speech due to weakness of tongue muscles.
  • Eye muscle weakness causes double vision and drooping eyelids. (Ocular Myasthenia gravis)

As symptoms progress, they worsen over time and can become life-threatening.

What Causes Myasthenia Gravis?

There is no one specific cause of myasthenia gravis. Still, there is a combination of factors that contribute to the condition.

Myasthenia gravis is a disorder of the immune system that results in the destruction of acetylcholine receptors at the neuromuscular junction[2]. It results in receptor dysfunction, which causes weakness and difficulty with muscle control and movement.

Additional factors that contribute to myasthenia gravis include:

  • Genetics – Myasthenia Gravis is more common in individuals with a first-degree relative with the disease. It may be diagnosed as congenital myasthenia gravis.
  • Gender – The prevalence of myasthenia gravis is more significant in women than men.
  • Age – The likelihood of developing myasthenia gravis increases with age.
  • Pregnancy – Pregnancy can worsen myasthenia gravis, but some women experience improvement or no change in symptoms. It may be due to the many hormonal changes during pregnancy.
  • Toxins – Exposure to toxins such as alcohol or drugs can worsen myasthenia gravis by increasing acetylcholine receptor destruction.

People with myasthenia gravis are much more likely to be female and are often under 50 years old. The condition may develop in people of any race or ethnicity.

Myasthenia gravis usually appears together with autoimmune conditions like:

Other causes include infections, medications, and trauma. Suppose you have a family history of myasthenia gravis. In that case, you should speak with your doctor about the possibility of developing this condition. It is also possible to inherit the condition. However, due to the complexity of this disorder, it is not always easy to determine how and why it develops.

What Are The Symptoms Of MG?

Symptoms Of MG
Myasthenia Gravis is an autoimmune condition in which the body’s immune system attacks the neuromuscular junction. In this area, nerve signaling and muscle contraction meet.

Myasthenia gravis pathophysiology includes:

  • Excessive fatigue
  • Muscle weakness or atrophy
  • Difficulty swallowing
  • Dry mouth and dry eyes
  • Difficulty speaking, chewing, and swallowing due to muscle weakness
  • Drooping eyelids and a loss of facial expression due to muscle weakness
  • Tremor on both sides of your body or in one specific part of your body
  • Difficulty breathing or lung problems
  • Fainting or feeling dizzy when you move from a sitting to a standing position

Many factors are associated with the differences in peoples’ manifestations of Myasthenia Gravis. One is that MG is a very individualized disease, meaning that it affects people differently.

Additionally, the symptoms of MG[3] can vary over time and with different triggers or medications. Another factor contributing to differences in the symptoms manifested by people living with MG is that there is no specific ‘template’ for the disease.

Symptoms may vary from person to person and even from day to day. It means that it is possible for two people who are both living with MG to experience different symptoms at any given time.

Unfortunately, there is no pinpoint way to know how your symptoms will affect you or another person.

How Is MG Diagnosed?

Diagnosing myasthenia gravis is made through a medical history and physical examination.

1. Blood Tests

Blood tests might be routinely performed to check for specific antibodies, which may indicate an autoimmune condition or infection, and check for the presence of antibodies that cause MG. The most effective test is an acetylcholine receptor antibody test. This test looks for antibodies that attack the acetylcholine receptors in the muscle. However, if these receptors are destroyed, they can no longer transmit nerve signals to the muscles.

Antibodies are not always present, so blood tests may be negative. Antibodies may rise and fall over time. It can take years for antibodies to develop and show up on blood tests. The blood test is more accurate than other tests, but it is expensive and not widely available. Researchers are working on much better ways to detect these antibodies early on and in low amounts.

2. Medical History/Scan Results

Myasthenia Gravis is diagnosed based on the signs and symptoms a person experiences, their medical history, and the results of blood tests. It can include nerve tests, such as computerized tomography (CT) scans or magnetic resonance imaging (MRI). In some cases, doctors may perform a tissue biopsy from the spinal cord.

3. Nerve Tests

Nerve tests can help confirm a diagnosis by showing whether there are abnormal electrical signals in the nerves. It can be done with an electrodiagnostic test, where electrodes record the electrical activity of the nerves. The test may show slow waves (or paralysis) in the nerve signals. Another test may indicate that there is weakness in muscles or reflexes.

Sometimes, confirming a diagnosis based on symptoms alone can be challenging. It is particularly true if the disease is relatively mild and goes unnoticed for many years before it becomes more severe.

How Can MG Be Treated?

The best treatment for MG is to prevent its progression. If you have been diagnosed with MG, following a diet that limits your intake of foods that can trigger it is essential. Avoid foods high in carbohydrates and protein, and keep your salt intake relatively low. Additionally, you should exercise regularly, as this will help reduce the risk of developing symptoms.

In some cases, medication may be prescribed to treat MG. The goal is to suppress the immune system, so it doesn’t attack the myasthenia muscles. It can be done by taking either low-dose anticholinesterase medications or antimuscarinics.

However, myasthenia gravis medications can slow down the heart rate and blood pressure over time and should only be used if all other tried treatments are ineffective.

Finally, emerging research shows that stem cell therapy may be an effective treatment for MG. Although further research needs to be conducted before a definitive conclusion can be drawn, this approach holds great promise for those who have not responded well to other therapies.

While there is no cure for myasthenia gravis, it can be treated with medicines that weaken the affected muscles. There are several different types of myasthenia gravis medications available. Some medicines are given by injection under the skin, while others are taken by mouth.

In some cases, myasthenia gravis can be treated with a combination of both types of medication. There is no set timeline for when to start treatment for myasthenia gravis. The first step is to check in with your doctor to determine the type and severity of your disease and what treatments may work best for you.

When treating myasthenia gravis, you must have regular checkups with your doctor and make sure that you take all of your prescribed medications as directed.

Conclusion

Myasthenia gravis is an autoimmune disease that weakens the connections between nerves and muscles. These weakened connections result in weakness of the muscles, especially with exertion.

Although there is no cure for MG, it can be treated with various medications that suppress the immune system and prevent further damage to the muscles. If you experience any of these symptoms, you should visit your doctor for diagnosis and treatment.

Myasthenia gravis can be treated and managed, but you must seek treatment as soon as you are diagnosed with this autoimmune disease.

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