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Myasthenia Gravis

What is myasthenia gravis?

Myasthenia gravis is a chronic, complex, autoimmune disorder in which antibodies destroy neuromuscular connections. This causes problems with communication between nerves and muscle, resulting in weakness of the skeletal muscles. Myasthenia gravis affects the voluntary muscles of the body, especially the eyes, mouth, throat, and limbs.

Women affected by myasthenia gravis generally see onset of the condition by age 20 to 30. In men, it usually starts after the age of 50. However, this condition can occur at any age. Males are more often affected than females.

What causes myasthenia gravis?

Myasthenia gravis is neither inherited, nor contagious. The disorder generally develops spontaneously later in life as a result of antibodies made in a person's body that attack normal receptors on muscle. This blocks the chemical released by the nerve endings (acetylcholine) from stimulating muscle contraction.

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A temporary form of myasthenia gravis may develop in the fetus when a woman with myasthenia gravis passes the antibodies to the fetus. Generally, neonatal forms of myasthenia gravis resolve in 2 to 3 months.

What are the symptoms of myasthenia gravis?

The following are the most common symptoms of myasthenia gravis. However, each person may experience symptoms differently. Symptoms may include:

  • Visual problems, including drooping eyelids (ptosis) and double vision (diplopia). About two-thirds of people with myasthenia gravis initially have these symptoms.
  • Severe muscle weakness and fatigue that may vary rapidly in intensity over days or even hours and worsen as muscles are used (early fatigue)
  • Facial muscle involvement causing a mask-like appearance; a smile may appear more like a snarl
  • Difficulty in swallowing and/or pronouncing words
  • Weakness of the neck and/or limbs

The symptoms of myasthenia gravis may resemble other conditions. Always consult your doctor for a diagnosis.

Flare-ups and remissions (easing of symptoms) may occur periodically during the course of myasthenia gravis. Remissions, however, are only rarely permanent or complete.

How is myasthenia gravis diagnosed?

The diagnosis of myasthenia gravis is made after the sudden or gradual onset of specific symptoms and after diagnostic testing. During the physical exam, the doctor will ask about your medical history and symptoms.

One common way to diagnose myasthenia gravis is to test how a person responds to certain medications. Muscle weakness often dramatically improves for a brief time when a person with myasthenia gravis is given an anticholinesterase medication. If a person responds to the medication, it confirms myasthenia gravis.

Other diagnostic tests that may be done to help confirm the diagnosis of myasthenia gravis include:

  • Blood tests. These tests look for antibodies that may be present in people with myasthenia gravis.
  • Genetic tests. Diagnostic tests that evaluate for conditions that have a tendency to run in families.
  • Electromyogram (EMG). A test that measures the electrical activity of a muscle or a group of muscles. An EMG can detect abnormal electrical muscle activity due to diseases and neuromuscular conditions.

How is myasthenia gravis treated?

Specific treatment for myasthenia gravis will be determined by your health care provider based on:

  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

There is no cure for myasthenia gravis, but the symptoms can generally be controlled. Myasthenia gravis is a lifelong medical condition and the key to medically managing it is early detection.

The goal of treatment is to increase muscle function and prevent swallowing and breathing problems. Most people with this condition can improve their muscle strength and lead normal or near normal lives. In more severe cases, respiratory or nutritional support may be needed.

Treatment may include:

  • Medications. Anticholinesterase medications, such as Prostigmin or Tensilon; steroids; and/or immunosuppressive (suppress the immune system’s response) medications may be used.
  • Thymectomy. This involves surgical removal of the thymus gland. The role of the thymus gland in myasthenia gravis is not fully understood, and the thymectomy may or may not improve symptoms. However, thymectomy reduces symptoms in more than 70% of people who do not have cancer of the thymus, possibly by altering the immune system response.
  • Plasmapheresis. A procedure that removes abnormal antibodies from the blood and replaces the blood with normal antibodies through donated blood.
  • Immunoglobulin. A blood product that helps to decrease the immune system’s attack on the nervous system, given intravenously (IV).

What are the complications of myasthenia gravis?

Myasthenia crisis is a condition of extreme muscle weakness, particularly of the diaphragm and chest muscles that support breathing. Breathing may become shallow or ineffective. The airway may become obstructed because of weakened throat muscles and secretion accumulation. Myasthenia crisis may be caused by a lack of medication or by other factors, such as a respiratory infection, emotional stress, surgery, or some other type of stressor. In severe crisis, a person may have to be placed on a ventilator to assist breathing until muscle strength returns with treatment.

Precautions, which may help to prevent or minimize the occurrence of myasthenia crisis, include, but are not limited to, the following:

  • Taking anticholinesterase medications 30 to 45 minutes prior to meals to reduce the risk of aspiration (food entering the lung passages)
  • Taking anticholinesterase medications precisely as ordered by the doctor to help maintain the strength of the breathing muscles
  • Avoiding crowds and contact with people with respiratory infections, such as a cold or the flu
  • Taking in proper nutrition to maintain optimal weight and muscle strength
  • Alternating periods of physical activity with periods of rest
  • Using stress-reduction techniques and avoiding emotional extremes

Notify any health care provider of your condition when any medications are being prescribed as certain medications may interfere either with the disease or the action of the medications you take for myasthenia gravis.

Living with myasthenia gravis

There is no cure for myasthenia gravis, but the symptoms can generally be controlled. Myasthenia gravis is a lifelong medical condition and the key to medically managing it is early detection.

The goal of treatment is to increase general muscle function and prevent swallowing and breathing problems. Most people with myasthenia gravis can improve their muscle strength and lead normal or near normal lives. In more severe cases, respiratory or nutritional support may be required..

When should I call my health care provider?

Call your doctor if any of the following occur:

  • Drooping eyelid
  • Blurred or double vision
  • Slurred speech
  • Problems chewing and swallowing
  • Weakness in the arms and legs
  • Chronic fatigue
  • Breathing difficulty

Key points about myasthenia gravis

  • Myasthenia gravis is a chronic, complex, autoimmune disorder in which antibodies destroy neuromuscular connections. This causes problems with communication between nerves and muscle, resulting in weakness of the skeletal muscles. It affects the voluntary muscles of the body, especially the eyes, mouth, throat, and limbs.
  • Myasthenia gravis is neither inherited, nor contagious.
  • There is no cure for myasthenia gravis, but the symptoms can generally be controlled.
  • Myasthenia gravis is a lifelong medical condition and the key to medically managing it is early detection.
  • The goal of treatment is to increase general muscle function and prevent swallowing and breathing problems.
  • Most people with this condition can improve their muscle strength and lead normal or near normal lives.
  • In more severe cases, respiratory or nutritional support may be required.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Myasthenia Gravis - WellSpan Health

Online Medical Reviewer: Fincannon, Joy, RN, MN
Online Medical Reviewer: Fraser, Marianne, MSN, RN
Last Review Date: 2014-01-15T00:00:00
Last Modified Date: 2016-03-29T00:00:00
Posting Date: 2014-01-15T00:00:00
Published Date: 2016-03-29T00:00:00
Last Review Date: 2007-03-30T00:00:00
© 2016 WellSpan Health. All Rights Reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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