Myasthenia gravis is a chronic disorder
characterized by weakness and rapid fatigue of any
muscles under your voluntary control. It results
from a breakdown in the normal communication between
nerves and muscles.
The disorder affects only the function of your
nerves and muscles - the muscle weakness you
experience improves with rest. In moderate to severe
cases, myasthenia gravis may cause difficulties with
speech, chewing, swallowing and breathing, as well
as weakness of your limbs.
Myasthenia gravis can affect people of any age,
but it's more common in women younger than 40 and in
men older than 60. Treatments are available to
control myasthenia gravis and relieve symptoms
Signs and symptoms
Myasthenia gravis may affect any of the muscles that you control
voluntarily. It most commonly affects certain muscles, including those
of the face, eyes, arms and legs, and those involved in chewing,
swallowing and breathing. Signs and symptoms may include:
muscle weakness, including drooping eyelids
breathing, talking, chewing or swallowing
Muscle weakness in
your arms or legs
brought on by repetitive motions
The more often a muscle action is repeated, the worse the weakness
becomes. In myasthenia gravis, good days alternate with bad. Remissions
may occur, however, and can last for months. In rare cases, breathing or
swallowing problems worsen markedly, requiring emergency medical care.
When your nervous system functions normally, the chemical acetylcholine
transmits nerve impulses to your muscles. At specialized areas of your
muscles, called neuromuscular junctions, receptor sites receive impulses
and signal your muscles to contract at certain times, such as when you
raise a spoon to your mouth.
In myasthenia gravis, there's a breakdown in communication between your
nerves and your muscles. The culprit is your immune system. For unknown
reasons, myasthenia gravis causes your immune system to produce
antibodies that block or destroy many of your receptor sites for
acetylcholine. With fewer receptor sites, your muscles receive fewer
nerve signals, resulting in the weakness. The degree of muscle weakness
varies greatly from person to person.
It's believed that the thymus gland, a part of your immune system
located in the upper chest beneath the breastbone, may trigger or
maintain the production of these antibodies. Large in infancy, the
thymus is small in healthy adults. Some people with myasthenia gravis,
however, have an abnormally large thymus gland. Some of these develop
tumors of the thymus. Usually, thymus gland tumors are noncancerous
Some factors can make myasthenia gravis worse, including illnesses such
as a cold, stress and overexertion.
When to seek medical advice
If you experience muscle weakness or have difficulty controlling the
muscles of your eyes, face and mouth, have trouble breathing or
experience fluctuating weakness in your arms and legs, see your doctor.
These signs could be indications of myasthenia gravis. Although there's
no cure for myasthenia gravis, the outlook for managing its symptoms is
good. The earlier you see your doctor, the sooner treatments can be
initiated to help you improve your muscle strength, and the sooner you
can learn about strategies to help you use your energy in the most
Screening and diagnosis
The key symptom that points to the possibility of myasthenia gravis is
muscle weakness that improves with rest. Tests to confirm the diagnosis
This may include testing of your reflexes, muscle strength, muscle
tone, senses of touch and sight, gait, posture, coordination,
balance and mental skills.
During the first part of this test, a small electrical impulse is
applied to your skin, stimulating your nerves in order to test the
strength of your muscle contraction. In the second part, a
thin-needle electrode inserted into one of your muscles helps
measure patterns of electrical activity in your muscle at rest and
with slight muscle contraction.
A blood test may reveal the presence of abnormal antibodies that
disrupt the receptor sites where nerve impulses signal your muscles
Injection of the chemical edrophonium (Tensilon) may result in a
sudden, although temporary, improvement in your muscle strength, an
indication that you may have myasthenia gravis. Edrophonium acts to
block an enzyme that inhibits the transmission of signals from your
nerve endings to your muscle receptor sites.
Doctors use a variety of treatments, alone or in combination, to relieve
symptoms of myasthenia gravis:
Several drugs, called cholinesterase inhibitors, enhance
communication between nerves and muscles. These drugs don't treat
the underlying problem, but they do improve muscle contraction and
muscle strength. Cholinesterase inhibitors include neostigmine (Prostigmin)
and pyridostigmine (Regonol, Mestinon). Corticosteroids inhibit the
immune system, limiting antibody production. Prolonged use of
corticosteroids can lead to serious side effects, such as bone
thinning, weight gain, diabetes, increased risk of some infections
and a redistribution of body fat. Your doctor may also prescribe
other medications that alter your immune system, such as
cyclophosphamide (Cytoxan, Neosar) and azathioprine (Imuran).
Removal of the thymus gland brings marked relief to more than half
the people with severe myasthenia gravis, but the effect is often
delayed for many years, and the response is more dramatic in younger
This procedure can remedy life-threatening stages of myasthenia
gravis. Plasmapheresis involves removal of antibodies from your
blood that block transmission of signals from your nerve endings to
your muscles' receptor sites. Blood is taken from your body, passed
through a filter that removes the specific antibodies and then
returned to your body. This approach is expensive and
time-consuming. Also, other forms of therapy are necessary for
long-term restoration of muscle strength. Otherwise, the immune
system soon makes new antibodies to replace those that have been
As part of your treatment, your doctor may suggest physical therapy and
occupational therapy to help you adjust to tasks you need to do around
the house and in your job.
Therapeutic plasmapheresis is a process in which the fluid part of the
blood, called plasma, is removed from blood cells by a device known as a
Supplementing your medical care with these approaches may help you make
the most of your energy and cope with the symptoms of myasthenia gravis:
Try to eat when you have good muscle strength, possibly an hour
after taking your medication. Also, take your time eating and rest
between bites. Try soft foods and avoid sticky foods.
precautions at home.
Install grab bars or railings in places where you may need support,
such as next to the bathtub. Keep the floors and halls in your house
clear of clutter, cords and loose rugs. Outside your home, keep the
steps, sidewalk and path to your car clear.
appliances and power tools.
Save your energy in the bathroom, in the kitchen or at the workbench
by using electric appliances, such as toothbrushes, can openers and
Wear an eye
If you have double vision, using an eye patch can help relieve this
effect. Wear the patch while you read or watch television. To avoid
eyestrain, occasionally switch the patch from one eye to the other.
If you have a chore to do around the house, shopping to do or an
errand to run, plan the activity to coincide with the time at which
your medication provides your peak energy level. If you're working
on a project at home, gather everything you need for the job at one
time, to eliminate extra trips that may drain your energy.
Ask for help.
Depending on your energy level, you may not be able to do everything
you have planned around the house or run every errand that you need
to. Ask family members and friends to lend a hand.
Because emotional stress can make myasthenia gravis worse, look for
ways to reduce stress. These may include relaxation techniques such
as biofeedback and meditation.
medicine with Complementary and Alternative medicine
and mind-body-spirit approaches to health and
Live Blood Analysis
of blood under a specialized high powered ultra-dark
field microscope, reveals anomalies in the blood.
tool for prevention.
is recognized by most as
the most powerful and versatile therapy known in
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Contact the Doctor
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This information is
provided for general medical education purposes only and
is not meant to substitute for the independent medical
judgment of a physician relative to diagnostic and
treatment options of a specific patient's medical
In no event will The Integrated Medical Clinic be liable for any
decision made or action taken in reliance upon the
information provided through this web site.
Mai 50000, Thailand