A weakness in your arm or leg muscles, double vision, or drooping eyelids can cause alarm, as these symptoms can sometimes indicate a stroke. However, in rare cases, it can signal an autoimmune condition called myasthenia gravis. While the condition can occur in anyone, at any age, it usually starts in women under 40 and men over 60.
In an interaction with the OnlyMyHealth team, Dr Nitin Kumar Sethi, Chairman of the PSRI Institute of Neuroscience, PSRI Hospital, New Delhi, sheds light on the disorder and shares ways to manage the condition, since it has no cure so far.
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What Is Myasthenia Gravis?
“Myasthenia gravis is an autoimmune neurological illness that affects the neuromuscular junction, leading to weakness and, at times, difficulty breathing when respiratory muscles get involved,” says Dr Sethi.
He explains, “Your nerves interact with your muscles by releasing chemicals known as neurotransmitters, which bind to receptor sites on muscle cells at the nerve-muscle junction. In myasthenia gravis, the immune system creates antibodies that block or destroy many of your muscles' acetylcholine receptor sites. With fewer receptor sites, your muscles get fewer nerve impulses. This results in weakness.”
Those who suffer from the disorder often complain of muscle weakness, which increases after exertion and improves with rest.
The prevalence rate of myasthenia gravis worldwide is estimated to be 150-200 cases per million people, according to a 2021 study published in the Journal of Clinical Medicine. In the United States, the estimated prevalence is 20 cases per 100,000 people, as per StatsPearls Publishing.
Research suggests that the condition is more common in females less than 40 years of age and males greater than 50 years of age. Additionally, childhood myasthenia gravis is rare in the western populations but is prevalent in Asian countries, with the involvement of around 50% of patients aged less than 15 years.
Symptoms Of Myasthenia Gravis
Myasthenia gravis can affect any muscle group. Some muscle groups are more frequently impacted than others.
According to Dr Sethi, the initial symptoms of myasthenia gravis involve the eyes and can induce drooping of one or both eyelids, known as ptosis. Double vision, or diplopia, can be horizontal or vertical and improves or resolves when one eye is closed.
Symptoms affecting the facial and throat muscles can make speaking difficult, create swallowing issues, affect eating, and may lead to aspiration. Myasthenia gravis can produce weakness in the neck, arms, and legs. Weakness in your legs might impact how you walk. Weak neck muscles make it difficult to lift the head (a condition called head drop).
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Can Myasthenia Gravis Be Cured?
Unfortunately, myasthenia gravis is incurable. Scientists are yet to find a cure for the condition. However, listed below are a few treatment options available:
- Medicines such as pyridostigmine and steroids; thymectomy is recommended if the thymus gland is enlarged (thymoma).
- Acetylcholinesterase Inhibitor medicines improve communication between neurones and muscles, reducing muscular weakness and fatigue.
- Steroids may be introduced for further improvement.
- Immunosuppressant drugs can treat severe or refractory myasthenia gravis symptoms by suppressing the immune system and reducing the circulating autoimmune antibodies.
- Intravenous Immunoglobulin (IVIG) Therapy and Plasma Exchange (Plasmapheresis) therapy are done usually when a patient presents with severe weakness, a condition referred to as myasthenic crisis.
Lifestyle Changes And Self Care Tips To Manage Myasthenia Gravis
Dr Sethi recommends certain lifestyle changes and self-care tips to manage myasthenia gravis. “A well-balanced diet and lots of rest can be quite beneficial, in addition to relaxation practices such as mindfulness and meditation, as well as light exercise like Tai Chi,” he says.
It is important to note that when myasthenia is not under control, exercise weakens the muscles. As a result, people should exercise within limitations that do not surpass their current abilities, warns the doctor. “Pace yourself and avoid overdoing things. Concentrate your efforts during your most productive hours of the day. Listen to your body and don't push it too far. Accept that myasthenia will cause both good and terrible days.”
“Lastly, keep an eye on the weather; fluctuations in temperature can have a visible impact on muscular function, and high temperatures can aggravate symptoms. Patients should be aware that myasthenia can worsen due to an infection and should seek medical care as early as possible,” he concludes.