Myasthenia Gravis: Symptoms, Causes, diagnosis and treatment (1)

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Myasthenia Gravis
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Myasthenia Gravis

• Myasthenia Gravis is a neuromuscular disorder
  primarily characterized by muscle weakness and
  muscle fatigue. Although the disorder usually
  becomes apparent during adulthood, symptom onset
  may occur at any age. The condition may be
  restricted to certain muscle groups, particularly
  those of the eyes (ocular myasthenia gravis), or
  may become more generalized (generalized
  myasthenia gravis), involving multiple muscle
  groups. Most individuals with myasthenia gravis
  develop weakness and drooping of the eyelids
  (ptosis) weakness of eye muscles, resulting in
  double vision (diplopia) and excessive muscle
  fatigue following activity.

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What are the causes of Myasthenia Gravis?

• Myasthenia Gravis is a neuromuscular
  disorder that is usually caused by an autoimmune
  problem. Autoimmune disorders occur when the
  immune system mistakenly attacks healthy tissue.
  In this condition, antibodies (proteins which
  normally attack foreign, harmful substances in
  the body) attack the neurotransmitter substance
  called acetylcholine, which is a crucial
  substance for nerve cell and muscle
  communication. This results in the muscle
  weakness that characterizes the condition. The
  exact cause of this autoimmune reaction is
  unclear to the doctors.

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Who is at risk?

• Myasthenia Gravis  is not inherited, and it is
  not contagious. It is not clear why people
  develop the disorder, although some researchers
  believe it could be from a genetic problem. For
  women, the disorder usually starts in their 20s
  and 30s for men, usually after age 50.

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Symptoms

• The main symptom of Myasthenia Gravis is
  weakness in the voluntary skeletal muscles, which
  are the muscles under your control. This weakness
  occurs with activity and can get better with
  rest. The failure of the muscles to contract
  normally occurs because they cannot respond to
  the nerve impulse. This is considered to be a
  blocked communication between nerve and muscle,
  and without the proper transmission of the
  impulse, weakness results. Weakness associated
  with MyastheniaGravis typically gets worse with
  more activity and improves with rest. Symptoms
  may include 
• Trouble talking
• Problems walking up stairs or lifting objects

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Symptoms
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• Facial paralysis
• Difficulty breathing because of muscle weakness
• Difficulty swallowing or chewing
• Fatigue
• Hoarse voice
• Drooping of eyelid
• Double vision
• Not everyone will have every symptom, and the
  degree of muscle weakness can change from day to
  day. The disease typically progresses over time
  if left untreated.

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How Myasthenia Gravis is diagnosed?

• Your doctor will perform a complete physical
  exam, as well as take a detailed history of
  symptoms. He or she will also do a neurological
  exam. This may consist of 
• Checking your reflexes
• Looking for muscle weakness
• Checking for muscle tone
• Making certain your eyes move properly
• Testing sensation in different areas of your body
• Seeing if you can perform certain movements, like
  touching your finger to your nose

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How Myasthenia Gravis is diagnosed?
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• Other tests that can help your doctor diagnose
  the condition include Repetitive nerve
  stimulation test
• Blood testing for antibodies associated with
  Myasthenia Gravis
• Edrophonium (Tensilon) test a drug called
  Tensilon (or a placebo) is injected, and the
  patient is asked to perform muscle movements
  under doctor observation
• Imaging of the chest, using CT scans or MRI, to
  rule out a tumour

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Treatments

• Common treatments for myasthenia gravis
  includeMedications such as Mestinon
  (pyridostigmine bromide) and Prostigmin
  (neostigmine bromide)
• Corticosteroid medications such as prednisone
• Medications that suppress the immune system, such
  as Imuran (azathioprine) and cyclosporine
• Removal of the thymus gland (thymectomy), the
  main gland in the immune system
• Plasma exchange (plasmapheresis), in which the
  person's blood plasma containing the abnormal
  antibodies is removed and fresh plasma is put
  back

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Treatments
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• People with myasthenia gravis can in most cases
  lead full lives. Sometimes the muscle weakness
  resolves to the point of not being a problem
  (called spontaneous remission). For some people,
  the weakness is only in the eyelids. For others,
  the weakness progresses to a point and stays at
  that level. Rarely, and usually in the first two
  years of the disorder, the weakness might extend
  to the muscles that control breathing, and the
  person will have to be hospitalized. There is no
  cure for myasthenia gravis, but the treatments
  are usually effective in minimizing its problems.

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