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Myasthenia Gravis

Myasthenia gravis is an autoimmune disorder (when your immune system attacks healthy tissues) that causes muscle weakness.

Myasthenia gravis affects the voluntary muscles; those most commonly affected are the muscles responsible for swallowing, facial expressions and eyelid movements.

When symptoms occur only in the eyes, it is known as ocular myasthenia gravis. In rare cases, children are born with congenital myasthenia gravis disease.

Myasthenia gravis symptoms

  • Myasthenia gravis symptoms include the following:
    • Droopy eyelid, in either one or both eyes (often one of the first noticeable symptoms)
    • Difficulty swallowing (dysphagia)
    • Blurred or double vision
    • Difficulty breathing (dyspnea)
    • Trouble talking

Myasthenia gravis: what you should know

  • Patients with myasthenia gravis are at higher risk of having co-existing conditions, such as other autoimmune disorders (like rheumatoid arthritis or lupus) and sarcoidosis.
  • If you have myasthenia gravis, you can face serious complications if you contract influenza (flu) or pneumonia. For this reason, it is important to get a yearly flu shot and a pneumonia vaccine at least once. 
  • With the help of specialists, such as neuromuscular experts at Rush, patients with myasthenia gravis can often achieve partial or complete control of their symptoms and return to normal function. 

How can I get help for myasthenia gravis?

  • If you have any of the above symptoms, contact your primary care physician. If your primary care doctor recommends further testing, neuromuscular experts at Rush can help you obtain an accurate diagnosis and begin treatment.
  • Diagnostic tests for myasthenia gravis may include the following:
    • Nerve conduction study and electromyography (EMG). This test looks for damage in the junctions where muscles meet nerves and measures your nerve function and health.
    • Repetitive nerve stimulation, stimulates a specific nerve multiple times to test muscle fatigue
    • Blood tests, detect the presence of certain antibodies that are often elevated in patients with myasthenia gravis
    • Imaging tests, such as CT or MRI, detect whether you have a thymoma (tumor on the thymus gland), which is common in patients with myasthenia gravis

Care for myasthenia gravis at Rush

Your doctors will work with you to recommend the level of care that will best meet your needs. Your care may include some of the following:

Medications

Your neuromuscular doctors can offer you the latest prescription medicines for myasthenia gravis. The neuromuscular experts at Rush are especially skilled at pinpointing the right medicine and dosage for each patient.

You and your doctor will likely discuss the pros and cons of various medication options, including the following, as well as closely monitor your side effects:

  • Anticholinesterase inhibitors: These medications provide temporary symptom relief by stopping the body’s break down by anticholinesterase of acetylcholine, which is needed for muscle contractions. Anticholinesterase inhibitors, such as pyridostigmine bromide (commonly referred to as Mestinon), are typically the first line of treatment for MG and are fast acting.    
  • Immunosuppressive medications: These medications can increase muscle strength by suppressing the body’s production of the abnormal antibodies that are causing muscle weakness. Since your immune system is being suppressed, you may be more susceptible to certain infections while taking these drugs.
  • Steroids: Prednisone is a steroid immunosuppressive medication that is frequently used to treat MG. It can cause serious side effects, including skin changes such as thinness and discoloration, insomnia and increased risk for developing high blood pressure, diabetes and osteoporosis.

Other therapies

These therapies are typically reserved for urgent cases of swallowing or breathing difficulties when a patient can’t wait for medication to kick in.

  • Intravenous immune globulin therapy: Also referred to as IVIg, intravenous immune globulin therapy uses donated blood to provide the body with normal antibodies. IVIg is expensive and offers short-term benefit.
  • Plasmapheresis: Also referred to as “plasma exchange,” plasmapheresis involves removing antibodies from the blood, and replacing it with antibody-free blood plus albumin, which replaces some of the proteins that are lost. Plasmapheresis is expensive with short-term benefit.

Treatment of myasthenic crisis 

A myasthenic crisis (when your muscles become too weak to support breathing on your own and you require a respirator) is always an emergency situation that requires immediate attention.

Neuromuscular physicians at Rush are adept at helping patients in the midst of a myasthenic crisis get out of the crisis. In addition, they will work with you to develop a treatment regimen that keeps your condition under control to prevent a crisis.

Thymectomy

Some patients with a thymoma can achieve remission by undergoing a surgery called thymectomy to remove the tumor.

At Rush, thoracic surgeons are able to perform this procedure using minimally invasive techniques that allow the surgeon to remove the thymus through only a small incision in the neck. These techniques typically shorten the length of stay in the hospital and speed the recovery from surgery.

Why choose Rush for myasthenia gravis care

  • Neuromuscular physicians have conducted thousands of muscle and nerve tests on adults, children and infants. As a result, they can detect subtle abnormalities in muscles and nerves and arrive at a diagnosis with great accuracy.
  • Neuromuscular experts at Rush collaborate with other specialists at Rush when needed to treat  common conditions that result from drug side effects, such as osteoporosis and steroid-induced diabetes.
  • Thoracic surgeons at Rush are able to perform transcervical thymectomy via a minimally invasive procedure rather than open surgery. This allows the surgeon to remove the thymus through a small incision in the neck.

Departments and programs that treat this condition