How Is Ocular Myasthenia Gravis Different From Generalized Myasthenia Gravis
Ocular myasthenia gravis only affects the muscles that move the eyes and eyelids. The symptoms of ocular myasthenia gravis include double vision , trouble focusing, and drooping eyelids. On the other hand, generalized myasthenia gravis affects muscles throughout the body. In addition to visual symptoms, generalized myasthenia gravis may cause trouble speaking, trouble swallowing, and weakness in the arms or legs.
What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.
Although there is no cure for myasthenia gravis, management of the disorder has improved over the past 30 years. There is a greater understanding about the causes, structure and function of the neuromuscular junction, the fundamental aspects of the thymus gland and of autoimmunity. Technological advances have led to more timely and accurate diagnosis of myasthenia gravis and new and enhanced therapies have improved treatment options. Researchers are working to develop better medications, identify new ways to diagnose and treat individuals, and improve treatment options.
Medication
Some people with myasthenia gravis do not respond favorably to available treatment options, which usually include long-term suppression of the immune system. New drugs are being tested, either alone or in combination with existing drug therapies, to see if they are more effective in targeting the causes of the disease.
Diagnostics and biomarkers
Assistive technologies, such as magnetic devices, may also help people with myasthenia gravis to control some symptoms of the disorder.
How Do You Treat Myasthenia Gravis
There are various types of treatments available for myasthenia gravis that would be done alone or in combination, and it helps relieve the signs and symptoms of myasthenia gravis. The treatment of myasthenia gravis depends on the patients age and its severity . The treatment includes medication, surgery, and intravenous therapies.
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How Can Double Vision Be Treated
Double vision that results from myasthenia gravis is most often treated by blocking the vision from one eye. Either an eye patch can be worn or scotch tape can be placed over one lens in the eyeglasses. If one eyelid is very droopy and blocks the vision in that eye, the double vision will not require a separate treatment. Usually special glasses with prisms are not helpful because of the considerable fluctuation in the amount of double vision in patients with myasthenia gravis.
How Is Yale Medicine’s Approach To Myasthenia Gravis Unique
Clinicians at Yale Medicine are determined to find the right treatment for each individual. The Myasthenia Gravis Clinic emphasizes precision medicine, or customized treatment determined by each patients specific symptoms and medical history. The risks and benefits of each therapeutic option is carefully considered and discussed with each patient. The clinic is also designated by the Myasthenia Gravis Foundation of America as a national “Partner in MG Care” site.
Patients at the clinic have the option of enrolling in clinical trials of new, not-yet-approved therapies and other advanced diagnostics.
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Signs And Symptoms Of Myasthenia Gravis
The muscle weakness caused by myasthenia gravis is typically at its worst after periods of physical activity and gets better following rest.
However, the muscles that control eye and eyelid movement, facial expressions, chewing, talking, and swallowing are often affected, making certain everyday activities challenging.
The onset of myasthenia gravis can be sudden in some people, and the degree of muscle weakness varies from person to person.
The condition can be challenging to diagnose because its symptoms mirror those of several other conditions, including generalized fatigue, amyotrophic lateral sclerosis , and botulism.
Although symptoms vary slightly from one person to the next, most people with myasthenia gravis will experience at least some of the following:
- Weakness of the arms, hands, fingers, legs, and neck
- Weakness of the eye muscles
- Drooping of one or both eyelids
- Blurred or double vision
- Medication such as beta-blockers, quinidine gluconate, quinidine sulfate, quinine, phenytoin, some anesthetics, and some antibiotics
Even though some types of medication have been shown to worsen the symptoms of myasthenia gravis, they may still be used if its more important to treat another underlying health condition, such as an infection or high blood pressure.
If drug treatment for another condition is worsening your myasthenia gravis, ask your doctor if there are other options.
How Often Does Myasthenia Gravis Only Affect The Eyes
For about one half of patients with myasthenia gravis, the first symptoms are visual. About 15% of these patients will remain only having visual symptoms, even years after their diagnosis. In the other 85% of patients, however, symptoms of weakness will develop in another part of the body, usually within the next three years. At that time, these patients are considered to have generalized myasthenia gravis.
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Does Myasthenia Gravis Cause Fatigue
Myasthenia gravis is a chronic autoimmune disease that reduces the muscle strength and the ability for the muscles to engage in repetitive muscle movements, these occur due to a problem in the neuromuscular junction.
Fatigue is extreme tiredness, lack of energy, and difficulty in concentrating in spite of adequate rest and nutrition. Muscle fatigability is difficulty in initiation of muscle movement and/or sustaining that muscle movement. Fatigue is a very subjective feeling there is no proper definition or parameter to identify the severity of it. Fatigue depends on certain physical and psychological factors therefore, it is difficult to get an objective idea about fatigue when a patient complains of it. Fatigue can be either physical fatigue or mental fatigue or both. Chronic fatigue is the presence of fatigue above a certain limit for 6 months or more.
When Do Visual Symptoms Of Myasthenia Gravis Develop
For about one half of patients with myasthenia gravis, the first symptoms are visual. About 15% of these patients will remain only having visual symptoms, even years after their diagnosis. In the other 85% of patients, however, symptoms of weakness will develop in another part of the body, usually within the next three years.
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What Are The Treatments For Myasthenia Gravis
One of the medications that is commonly used to treat myasthenia gravis is called pyridostigmine . This medication helps build higher levels of the chemical acetylcholine, which is the signal that tells a muscle to move. The side effects of pyridostigmine can include diarrhea, abdominal cramps, nausea, and vomiting. Another medication called glycopyrrolate can be used to reduce these effects.
Corticosteroid medications, such as prednisone, can also be used to help patients with myasthenia gravis. These medicines can be very effective at controlling the immune response that causes myasthenia. Unfortunately, long-term use of steroids is also associated with side effects that include osteoporosis , diabetes, high blood pressure, sleep disturbance, and emotional changes. In some cases, other medications can be used to help control the immune system and lower the dosage of prednisone. These medications include azathioprine , cyclosporine, and mycophenolate mofetil . Intravenous immunoglobulin is another medication that can be used intermittently and can be very effective.
If myasthenia gravis is diagnosed, a CT scan of the chest should be performed in order to look for a type of benign tumor called a thymoma. Many experts believe that if the thymus is enlarged, removing it can improve the symptoms of myasthenia. Thymomas are present more often in patients with generalized myasthenia gravis compared to those with ocular myasthenia gravis.
Prognosis Of Myasthenia Gravis
With treatment, most people with myasthenia see significant improvements in their muscle weakness, and they can lead normal or nearly normal lives.
Roughly 3 percent of people who develop the condition will die from it, and the risk for death is higher in those diagnosed at age 40 or older as well as those with thymoma.
Still, given the low risk for early death associated with myasthenia gravis, the gravis part of the name is now considered a misnomer.
In fact, some people with the condition may even experience remission a temporary or permanent absence of symptoms. Their muscle weakness may disappear completely.
If you experience remission, your doctor may discontinue your medication.
In addition, up to 50 percent of people who undergo thymectomy surgery experience stable, long-lasting complete remission.
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Causes And Risk Factors Of Myasthenia Gravis
Myasthenia gravis is caused by a breakdown in the normal communication between nerves and muscles that occurs at the neuromuscular junction, where your nerve cells connect with the muscles they control.
Normally, at the neuromuscular junction, when your brain sends electrical signals or impulses down a motor nerve, the nerve endings release a neurotransmitter called acetylcholine, which attaches, or binds, to sites in your muscles called acetylcholine receptors. This activates the muscle and causes a muscle contraction.
In people with myasthenia gravis, however, antibodies block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle from contracting. This is typically caused by antibodies to the acetylcholine receptor.
In addition, antibodies to a protein called muscle-specific kinase may also disrupt transmission at the neuromuscular junction.
Researchers also think that a part of your immune system called the thymus gland, situated in the upper chest beneath your breastbone, may trigger or maintain the production of the antibodies that block the neurotransmitter acetylcholine.
While the thymus is small in healthy adults, itâs abnormally large in some adults with myasthenia gravis.
In addition, tumors may be present in the thymus glands of people with myasthenia gravis, affecting antibody production. These tumors are called thymomas.
Myasthenia Gravis Treatment And Home Remedies
Your treatment will depend on your age, how severe your symptoms are, and how fast the condition is progressing. You might need one or several treatments together. Your doctor may recommend a medication such as:
- Cholinesterase inhibitors. These medications boost the communication between your nerves and your muscles. They can help strengthen muscles.
- Corticosteroids. Corticosteroids such as prednisone mute your immune system and slow the release of antibodies that could be helping block your nerve receptors.
- Immunosuppressants. Your doctor may add immunosuppressants to your corticosteroids to help reduce your immune system response.
- Neonatal Fc receptor blocker. It works by blocking the autoantibodies that cause myasthenia gravis and helps ease the symptoms.
If youâre dealing with a sudden worsening of symptoms or will soon have surgery or other therapies, your doctor may recommend intravenous therapy. Choices for this include:
If your myasthenia gravis is due to a tumor on your thymus gland, you may need surgery to remove the whole gland . Even if you donât have a tumor, taking your thymus out may help ease your symptoms. It may take years to see benefits from a thymectomy.
You may need open surgery to remove your thymus. A surgeon opens your breastbone to get to your thymus and take it out.
Another option that may work is minimally invasive surgery. There are two options:
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How Is Yale Medicines Approach To Myasthenia Gravis Unique
Clinicians at Yale Medicine are determined to find the right treatment for each individual. The Myasthenia Gravis Clinic emphasizes precision medicine, or customized treatment determined by each patients specific symptoms and medical history. The risks and benefits of each therapeutic option is carefully considered and discussed with each patient. The clinic is also designated by the Myasthenia Gravis Foundation of America as a national Partner in MG Care site.
Patients at the clinic have the option of enrolling in clinical trials of new, not-yet-approved therapies and other advanced diagnostics.
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What Is Myasthenia Gravis Symptoms Causes Diagnosis Treatment And Prevention
Myasthenia gravis is a chronic autoimmune neuromuscular condition that causes muscle weakness and severe fatigue.
The term myasthenia gravis is Latin and Greek in origin, and means âgrave muscle weakness.â
The condition primarily affects the skeletal muscles, or the muscles attached to bones and responsible for skeletal movement.
As many as 60,000 Americans are living with the condition, the Myasthenia Gravis Foundation of America says, but the disease often goes undiagnosed.
Currently, theres no cure for myasthenia gravis. However, available treatments usually can control symptoms, allowing those diagnosed with the condition to lead relatively normal lives.
In addition, most people with myasthenia gravis have a normal life expectancy.
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Cause Of Myasthenia Gravis
Myasthenia gravis is caused by a problem with the signals sent between the nerves and the muscles.
It’s an autoimmune condition, which means it’s the result of the immune system mistakenly attacking a healthy part of the body.
In myasthenia gravis, the immune system damages the communication system between the nerves and muscles, making the muscles weak and easily tired.
It’s not clear why this happens, but it’s been linked to issues with the thymus gland .
Many people with myasthenia gravis have a thymus gland that’s larger than normal. Around 1 in 10 people have an abnormal growth of the thymus called a thymoma.
What Medications Should Be Avoided
Certain medications can worsen the symptoms of myasthenia and should be avoided. These medications include specific antibiotics , beta-blockers, calcium channel blockers, and phenytoin . If a patient with myasthenia gravis requires a surgical procedure, the anesthesiologist should be aware and in order to use the proper medications.
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How Is Myasthenia Gravis Diagnosed
A doctor may perform or order several tests to confirm the diagnosis of myasthenia gravis:
Because weakness is a common symptom of many other disorders, the diagnosis of myasthenia gravis is often missed or delayed in people who experience mild weakness or in those individuals whose weakness is restricted to only a few muscles.
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Speech Problems In Myasthenia Gravis
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The key symptom of myasthenia gravis is muscle weakness that gets worse after activity. This usually gets better after rest. Certain muscles can be affected by the disorder, including the muscles that control talking and swallowing. The amount of muscle weakness can vary among people living with MG.1
Speech problems can occur in MG due to this muscle weakness. Knowing more about these problems ahead of time can help you manage these symptoms if they occur.
How Is Myasthenia Gravis Treated
Specific treatment for myasthenia gravis will be determined by your healthcare provider based on:
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How old you are
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How well you can handle specific medicines, procedures, or therapies
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How long the condition is expected to last
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Your opinion or preference
There is no cure for myasthenia gravis, but the symptoms can often be controlled. Myasthenia gravis is a lifelong medical condition. Early detection is the key to managing the condition.
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, help may be needed for breathing and eating.
Treatment may include:
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Medicine. Anticholinesterase medicines, steroids, or medicines that suppress the immune systemâs response medicines may be used.
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Thymectomy. This is 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, it reduces symptoms in more than 70% of people who do not have cancer of the thymus, possibly by altering the immune system response.
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Plasmapheresis. A procedure that removes abnormal antibodies from the blood and replaces the blood with normal antibodies from donated blood.
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Immunoglobulin. A blood product that helps decrease the immune systemâs attack on the nervous system. It is given intravenously .
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Impact On Quality Of Life
People with MG who had high rates of fatigue were also found to have high rates of depression and lower quality of life. Quality of life means feeling comfortable, happy, and able to do the things that you like or need to do. Fatigue lowers quality of life, which lowers motivation to get things done.1,2
Fatigue can also make it harder for people to socialize. The result is higher levels of depression. The cycle does not end there: Higher rates of depression can mean less motivation to get physical exercise. This means that the muscles can lose strength, which is a big problem for those with MG.1-4
