Treatment And Medication Options For Myasthenia Gravis
Myasthenia gravis is typically treated by a neurologist, and with treatment, the symptoms of myasthenia gravis can be well controlled. For example, a variety of therapies help to improve muscle weakness.
Your neurologist will determine which treatment option is best for you based on the following:
- Your age
- Any other medical conditions you have
Myasthenia Gravis : Definition Symptoms Causes Types Diagnosis Prognosis Pathophysiology Complications Treatment Living With Myasthenia Gravis
Myasthenia gravis is a serious neuromuscular and autoimmune disorder that leads to weakness in the skeletal muscles which gets worse after doing any activity. Myasthenia gravis has no known cure yet, but therapies are under practice to improve the quality of life for patients having this autoimmune disorder. The neuromuscular symptoms of myasthenia gravis get better after resting for a period of time. The name of Myasthenia Gravis comes from Latin and Greek origin which means serious or grave muscular weakness. The immune system mistakenly attacks on the skeletal muscles, these skeletal muscles are responsible for various important functions like moving body parts and breathing. However, the patients having myasthenia gravis can have a normal life expectancy but their quality of life decreases a lot due to inability to move.
How Does Ocular Myasthenia Gravis Cause Double Vision
Ocular Myasthenia Gravis. Weakness of the eye muscles leads to misalignment of the eyes, which causes the eyes to perceive the same object in two different locations. Double vision is a common symptom of myasthenia gravis because this condition very frequently affects the strength of the eye muscles.
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What Are The Risk Factors For Myasthenia Gravis
As is the case with other autoimmune diseases, MG has risk factors that are not well understood.
MG is considered a sporadic disease, meaning it can strike anyone, at any time. It can occur in people of all ethnic backgrounds and ages, but tends to be more common among women younger than 40, and men older than 60.
Symptoms Of Ocular Myasthenia Gravis
With ocular myasthenia gravis, the symptoms typically include ptosis and diplopia.
Ptosis: A drooping eyelid can be seen in either eye or in both eyes. The drooping may not be always visible, but will often follow a pattern that can be seen on physical examination by an ophthalmologist or other eye care professional.
If the patient looks upward for several seconds or up to a minute, they may be unable to keep one or both eyelids open enough to see. Sometimes the eyelids may also flutter.
Diplopia: Patients with ocular myasthenia gravis may experience double vision. This is due to a weakening of the eye muscles. In some cases, one of the ocular muscles will be unable to move properly, and this will cause the patient to see double.
The failure of an ocular muscle in the absence of trauma is not common. When an ophthalmologist sees this sign, it may prompt them a diagnosis of myasthenia gravis.
Other ocular symptoms: Some research has described other possible symptoms of ocular myasthenia gravis, including weakness of the upper eyelid, difficulty focusing, and difficulty turning both eyes inward when looking at an object at close range.
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Diagnosis And Differential Diagnoses
Diagnosis is by measurement of serum AChR antibody levels, electromyography, and in some cases IV edrophonium challenge, which briefly decreases the weakness bedside testing is discussed in Reference 8. MG can mimic other diagnoses in elderly persons and vice versa. Differential diagnoses include myocardial infarction, pulmonary embolism, multiple sclerosis, amyotrophic lateral sclerosis, basilar artery thrombosis, brainstem gliomas, chronic myelogenous leukemia, and polymyositis, among others. Additionally, other problems should be considered, such as depression, and as mentioned above, a drug-induced myasthenia-like syndrome , among others.9
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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What Causes The Muscle Weakness Associated With Myasthenia Gravis
Myasthenia gravis is an autoimmune disease, which means that a patients immune system overreacts, causing damage to organs or tissues in the body. In the case of MG, the immune system releases proteins that interfere with the normal communication between muscle and nerve cells and in turn, results in weakness.
Plus, like many autoimmune diseases, MGs exact cause is unclearit may have to do with genetic factors, environmental factors, or a combination of both. Although the condition occurs spontaneously in most patients, it could also be caused because of a thymoma, or noncancerous tumor on the thymus gland.
What Causes Myasthenia Gravis
Myasthenia gravis is not inherited and it is not contagious. It generally develops later in life when antibodies in the body attack normal receptors on muscle. This blocks a chemical needed to stimulate muscle contraction.
A temporary form of myasthenia gravis may develop in the fetus when a woman with myasthenia gravis passes the antibodies to the fetus. Generally, it resolves in 2 to 3 months.
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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 “grave muscle weakness.”
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.
Does Myasthenia Affect Reflexes
Weakness can be present in a variety of different muscles and is usually proximal and not symmetrical. Sensory examination and deep tendon reflexes are normal. Weakness of the facial muscles is almost always present. Bilateral facial muscle weakness produces a sagging and expressionless face, and a horizontal smile.
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What Organs Does Myasthenia Gravis Affect
- Myasthenia gravis is a chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles.
- Myasthenia gravis affects the voluntary muscles of the body, especially those that control the eyes, mouth, throat and limbs.
What Are The Symptoms Of Myasthenia Gravis
Patients with MG might first notice drooping eyelids, trouble chewing and swallowing, or slurred speech. MG can also cause muscle weakness in the legs or arms it can even cause breathing problems. Typically, motor control becomes worse during periods of exertion and gets better with rest.
Sometimes periods of muscle weakness come on so suddenly that a person may have trouble breathing and will require medical assistance. This type of acute episode, called a myasthenic crisis does not occur in most cases. However, these episodes can be exacerbated by a number of factors, including pregnancy, infection, surgery, or some other trauma.
Some patients will experience symptoms involving their eyes only, which is referred to as ocular MG.
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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, it’s 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.
How Is It Treated
It is not known exactly what causes fatigue in people with MG, but the studies mentioned above give us important clues. The most important clue is that people in remission from MG or who have few symptoms are less likely to feel fatigued.
This decrease in fatigue leads researchers to believe that fatigue can be treated, similar to other MG symptoms. In fact, in many of these studies, after treatment controlled MG symptoms, fatigue improved.1-4
While there are no therapies approved specifically to treat fatigue in MG, people with MG have recommended self-care practices. This includes getting plenty of rest, exercising, or getting therapy.
Because fatigue is a common symptom of MG that is related to worse MG symptoms and lower quality of life, it is important that your doctor is aware of it and helps you find treatments that work for you.4
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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. Early detection is key to managing this condition.
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, help may be needed with breathing and eating.
Treatments Options For Ocular Myasthenia Gravis
Because ocular myasthenia gravis is a well-described condition, there are several treatment avenues open to patients. Depending on the type and severity of the symptoms, treatment can include eyeglasses and surgery.
Myasthenia gravis is usually treated by team of physicians, and ocular symptoms in particular are generally treated by a neurologist working with an ophthalmologist.
Medications: Several different medications may be used to treat generalized myasthenia gravis, but there is no good evidence that any of these are effective at treating ocular symptoms. There is some evidence that treatment with medication may prevent ocular myasthenia gravis from progressing to generalized myasthenia gravis.
Many medications used to treat myasthenia gravis have the potential for significant side effects, and patients who are only experiencing ocular symptoms may not be good candidates for these drugs. This is especially true if symptoms can be managed with other, less risky methods.
Patching: Double vision can sometimes be treated by patching one eye. An opaque patch is fitted over the eye that is experiencing the symptoms of myasthenia gravis.
Eyeglasses: In cases in which double vision is the problem, special eyeglasses fitted with a Fresnel prism may be employed. These glasses bend the light in such a way as to eliminate double vision.
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What Is The Connection Between Thymus Gland Problems And Mg
Many people with MG have thymus gland conditions that may bring on MG. The thymus is a small organ in the upper chest that is part of the lymphatic system. It makes white blood cells that fight infections. Two-thirds of young people with MG have overactive thymic cells . About one in 10 people with MG have thymus gland tumors called thymomas, which may be benign or cancerous.
Surgery For Ocular Myasthenia Gravis
Most often, two different forms of surgery are used to treat ocular myasthenia gravis:
Strabismus surgery: This surgery is done on the muscles of the eyes in order to improve double vision and correct any underlying deviation of the eye . It might be done on patients whose myasthenia gravis does not appear to be progressing or in those whose eyes have a significant deviation.
During this surgery, a muscle that controls the eye is detached and then reattached so that it can better control the eyes movements. In some cases, the surgery may need to be repeated in order to fine-tune the eye alignment.
Blepharoptosis surgery: In some cases, medication or other therapies may not be effective for treating ptosis. In cases of persistent ptosis, blepharoptosissurgery may be considered to improve both the functioning of the eyelid and its cosmetic appearance. Some patients with ptosis may find their vision obstructed by the drooping eyelid, and are unable to read or drive.
During levator advancement or resection surgery, the eyelid droop is corrected by shortening the muscle that raises the eyelid. This is typically an outpatient surgery. The patient recovers at home, using ice packs on the eyes for a few days, followed by antibiotic eye and lubricating drops or ointment for one to three weeks.
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How Is Myasthenia Gravis Treated
Specific treatment for myasthenia gravis will be determined by your healthcare provider based on:
How old you are
How well you can handle specific medicines, procedures, or therapies
How long the condition is expected to last
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:
Medicine. Anticholinesterase medicines, steroids, or medicines that suppress the immune systemâs response medicines may be used.
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.
Plasmapheresis. A procedure that removes abnormal antibodies from the blood and replaces the blood with normal antibodies from donated blood.
Immunoglobulin. A blood product that helps decrease the immune systemâs attack on the nervous system. It is given intravenously .
Fatigue In Patients With Myasthenia Gravis A Systematic Review Of The Literature
- Central fatigue is highly prevalent in autoimmune Myasthenia Gravis.
- There is a strong association with disease severity, female gender and depressive symptoms.
- Central fatigue has a severe negative impact on quality of life.
- PAtients with central fatigue may benefit from Physical or psychological training programs.
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How Does Myasthenia Gravis Affect The Nervous System
Normally nerves send a signal to muscles using a chemical called acetylcholine, which tells the muscles when to move. In patients with myasthenia gravis, the bodys immune system mistakenly interferes with the muscles receptors for acetylcholine. When these receptors cannot work properly, the affected muscles tire easily.
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.
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Myasthenia Gravis What You Should Know
Myasthenia gravis is a neurological disorder that often affects the eyes. Eye conditions associated with ocular myasthenia gravis include diplopia and ptosis .
While medical therapy is often used to treat generalized myasthenia gravis, it is not clear whether medications are effective in treating ocular symptoms.
Other measures, such as eyeglasses with prisms, are frequently used. Surgery may be considered for those with severe symptoms that affect vision or are cosmetically undesirable.
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.
Clinical Manifestations And Complications
Symptomsof MG are outlined in TABLE 1. The usual initial complaint is a specific muscle weakness as opposed to a generalized weakness.9 Extraocular muscle weakness or ptosis is present initially in half of all patients and occurs during the course of illness in 90% of individuals.9 MG remains exclusively ocular in only 16% of patients.9 Ocular complaints are more common during the first year and are the presenting symptom in half of all cases often within 1 year, patients have generalized symptoms such as weakness or fatigue and one third of patients develop respiratory weakness, requiring mechanical ventilation.2,12 If generalized myasthenia is going to develop after ocular symptoms, it usually does so within the first 3 years.8 Some patients present with bulbar symptoms . Of note, hand grip may alternate between weak and normal, neck muscles may become weak, and proximal limb weakness is common.8 Sensation and deep tendon reflexes are normal. Manifestations fluctuate in intensity over minutes, hours, and days.8