• Myasthenia Gravis

    (MG)

    Definition

    Myasthenia gravis (MG) is an autoimmune disorder. The signal from the nerves to the muscles is blocked. As a result, the muscle cannot move and become increasingly weaker.
    Symptoms may grow more severe over time. This is a potentially serious condition. MG requires care from your doctor. If you suspect you have this condition, contact your doctor immediately.

    Causes

    The root cause of MG is unknown. It occurs when the body’s immune system attacks receptors in muscle. Normally, these receptors respond to the chemical acetylcholine (ACh). This chemical allows nerve signals to prompt the muscles to move. When the immune system prevents these receptors from working well, the muscles cannot respond to nerve signals.
    The thymus is thought to play a role in some cases of MG. The thymus is an organ behind the breastbone. Immune proteins called antibodies are produced there. It is these antibodies that may target the ACh receptors. It is still not clear why the thymus begins to produce these.
    The Thymus Gland
    si2141 97870 1 thymus gland
    Copyright © Nucleus Medical Media, Inc.
    Infants of mothers with MG are more likely to develop a temporary form. It is called neonatal MG. The mother’s abnormal antibodies enter the baby’s bloodstream. When the baby is born, there may be muscle weakness. The abnormal antibodies are often cleared from the baby in about two months. This will end the baby’s symptoms.

    Risk Factors

    The following factors increase your chance of developing MG:
      Sex and age:
      • Women between the ages of 10—30
      • Men between the ages of 50—60
    • People with certain genetic markers, called HLA-B8, DR3

    Symptoms

    Symptoms include:
    • Muscle weakness that increases with muscle use/exercise, and improves after resting those muscles
    • Weakness of muscles that control:
      • The eyelids
      • Eye movement
      • Facial expression
      • Chewing
      • Swallowing
      • Coughing
      • Breathing
      • Arm and leg movement
    • Drooping eyelids
    • Double and/or blurred vision
    • Difficulty swallowing
    • Difficulty speaking
    • Difficulty walking
    • Weakness of the hand muscles
    • Myasthenic crisis—a severe flare of symptoms, breathing may be significantly impaired

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to see a neurologist. This type of doctor is an expert in diseases of the nervous system.
    Tests may include the following:
    • Blood tests—to identify the presence of abnormal antibodies and to look for thyroid disease (more common in patients with MG)
    • Electromyography (EMG) tests—to reveal abnormalities in muscle functioning
    • Repetitive nerve stimulation—may show progressively increasing muscle weakness over the course of the test
    • Tensilon test—a dose of a medication called edrophonium chloride is given, which will briefly improve muscle weakness
    • Computed tomography (CT) or magnetic resonance imaging (MRI) scan of the chest—to look for a tumor of the thymus gland (thymoma)
    • Pulmonary function testing —to assess how MG may be affecting your ability to breathe

    Treatment

    Talk with your doctor about the best plan for you . Treatment options include:

    Acetylcholinesterase Inhibitors

    These drugs interfere with the breakdown of ACh. This increases the amount of ACh available to stimulate the muscle. These medications include:
    • Pyridostigmine
    • Neostigmine

    Immunosuppressive Therapy

    This therapy is given to suppress the immune system. As a result, there are fewer antibodies present to attack the receptors. These medications include:
    • Prednisone
    • Azathioprine
    • Mycophenolate mofetil
    • Cyclosporine
    • Cyclophosphamide
    • Tacrolimus

    Immunoglobulin Therapy

    Immunoglobulin given by IV might help reduce symptoms. The exact mechanism is unclear. This treatment seems to have fewer side effects that plasmapheresis.

    Plasmapheresis

    This is a procedure which cleans the blood of the abnormal antibodies. This process may need to be repeated at certain intervals.

    Thymectomy

    Removal of the thymus gland is recommended for most patients with MG. This surgery may improve the symptoms in some patients.

    Mechanical Ventilation

    This may only be needed if breathing is severely impaired. This can happen during an episode of myasthenic crisis.

    Physical and Occupational Therapy

    Therapy does not generally alter the course of the disease. It may be needed to help the patient cope with changes in muscle strength. It may also help with learning alternative ways to approach daily activities.

    Prevention

    There are no known ways to prevent MG. The following steps may improve muscle functioning in people who already have the condition:
      Avoid medicines that may worsen MG, such as:
      • Beta-blockers
      • Aminoglycoside antibiotics
      • Quinolone antibiotics
      • Class I medications used for abnormal heart rhythms
    • Treat any infections promptly.
    • If you have trouble swallowing, please notify your doctor immediately. You may wish to consult a dietitian to help you construct a healthy diet that is easier to swallow.
    • If you have trouble speaking, you may wish to consult a speech therapist.

    RESOURCES

    Myasthenia Gravis Foundation of America http://www.myasthenia.org/

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

    CANADIAN RESOURCES

    Muscular Dystrophy Canada http://www.muscle.ca/

    Myasthenia Gravis Association of BC http://www.myastheniagravis.ca/

    References

    Ferri FF, ed. Ferri’s Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby Elsevier; 2004.

    Goetz CG, ed. Textbook of clinical Neurology. 2nd ed. Philadelphia, PA: WB Saunders Company; 2006.

    Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: WB Saunders Company; 2004.

    Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55:7-15.

    Myasthenia gravis. DynaMed. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed February 1, 2009.

    Sanders DB, Howard JF. Disorders of Neuromuscular Transmission. Neurology in Clinical Practice website. Available at: http://www.expertconsultbook.com/expertconsult/b/book . Accessed February 1, 2009.

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.