Myasthenia Gravis – Causes, Symptoms, Treatment

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Myasthenia gravis is a neuromuscular disorder characterized especially by weakness and muscle fatigue. Although the disorder usually becomes apparent during adulthood, symptom onset may occur at any age. The disease may be restricted to certain muscle groups, especially those at the level of the eye (ocular myasthenia gravis) or can be generalized (generalized myasthenia gravis), here being involved multiple muscle groups.

Most people with myasthenia gravis develop the weakness and drooping of the eyelids (ptosis), weakness of the eye muscles, which results in double vision (diplopia) and excessive muscle fatigue following physical activities.The additional features of the disease’s symptomatology include weakness of facial muscles, impaired articulation of words (dysarthria); impaired chewing and swallowing (dysphagia) and weakness in the muscles of the upper arms and legs (proximal limb weakness). Also, in about 10% of the cases, affected individuals may develop potentially life-threatening complications due to respiratory muscle damage (myasthenic crisis).

2.Physiopathogenic mechanism

3.Symptoms

4.Investigation

5.Treatment

6.Measures to prevent the recurrence of symptoms

Physiopathogenic mechanism

 

Myasthenia gravis occurs due to an abnormal immune reaction, in which through the natural immune defense mechanisms of the body (e.g. the generation of antibodies)  some muscle receptors that receive nerve impulses (antibody-mediated autoimmune response) are inappropriately attacked and progressively destroyed

Symptoms

 

The main symptom of myasthenia gravis is the muscle weakness. This gets worse during physical activities. It may also be influenced by temperature, certain periods of time, stress and other related diseases.

There may be problems at the level of the eye. As a result, the patient may have diplopia or ptosis. Both get worse at the end of the day. The patient may encounter difficulties when chewing, swallowing or speaking. At the same time,  he may also have excessive salivation and may feature an impaired physiognomy, with a twisted smile.

Another manifestation of the disease is represented by the muscle weakness of the hands and feet. Because of this the patient may have difficulties at climbing stairs, washing and combing the hair. It is worth mentioning the fact that muscle weakness in the hands and feet is not usually the first symptom of myasthenia gravis.

There may be dyspnea (shortness of air). This is caused by the weakness of respiratory muscles. If shortness of breath appears one should contact the doctor.

Investigation

 

The doctor will perform a complete physical exam of the patient. Thus, he will test your reflexes and will try to identify the areas of muscle weakness.

If he suspects the patient of myasthenia gravis,the family doctor can guide him to a specialist who will perform several tests to confirm the diagnosis. These tests include:

- Electromyogram (EMG), which measures the electrical activity of the muscles as they contract after nerve stimulation; at patients with myasthenia gravis contractions become weaker

- Tensilon test to see how the patient responds to a drug that improves muscle strength; the drug temporarily restores muscle strength in people with myasthenia gravis

- a blood test may be performed to identify the antibodies associated with myasthenia gravis.

Treatment

 

There is a variety of treatment modalities of myasthenia gravis. The choice is made depending on the severity of the symptoms, age, gender and activity level. Drugs can help at the control of the symptoms of myasthenia gravis.

One way of treatment uses drugs that improve the relationship between the muscular system and nervous system. Such drugs have immediat effect  and the patient feels better, but their effects fade within a few hours.

Another approach uses drugs that suppress the immune system. It may take a longer period of time before this type of treatment taking effect.

Lifestyle changes can also help. It is recommend to have a healthy diet and an adequate rest.

 

It is recommended:

-  to always follow the doctor’s instructions

- to contact him in case of dyspnea

- trying to find a balance between rest and physical activity in order  to prevent the onset of muscle weakness

- carrying out physiotherapy sessions to increase muscle strength.

It is not recommended:

- weight gain

- to give up physical activity.

 

The recovery period

The maximum degree of muscle weakness occurs in the first three years in most patients. Although symptoms can be kept under control, it some medication changes may be necessary. At the level of severely affected muscles, a certain degree of residual weakness may persist. Most people manage to live a normal life. The probability for the muscle weakness  to be so severe as to require a wheelchair is very small.

Measures to prevent the recurrence of symptoms

 

-always follow the doctor’s instructions

-use of prescribed medication on a regular basis

-adopting a healthy life style.

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