Myasthenia Gravis

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

Myasthenia gravis affects your voluntary muscles. The ones most often affected at first are the muscles responsible for eye movements, including your eyelids. Muscles responsible for speech, swallowing, breathing, arm movements and leg movements can also be affected.

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)
• Blurred or double vision
• Difficulty swallowing (dysphagia)
• Difficulty breathing (dyspnea)
• Trouble talking
• Difficulty holding up your head
• Weakness in your arms or legs (often noticeable when using stairs, rising from a low seat or raising your arms)
• Muscle fatigue, especially at the end of the day

Myasthenia Gravis Diagnosis at Rush

Your myasthenia gravis diagnostic tests may include the following:

• Blood tests detect whether you have certain antibodies that are often higher in patients with myasthenia gravis.
• Imaging tests, such as CT or MRI, detect whether you have a tumor or enlargement of the thymus gland, which sometimes appear in patients with myasthenia gravis. (Benign enlargement is far more common than tumors.)
• Electromyography (EMG) and nerve conduction studies measure your nerve function and health and look for damage to the connections between nerves and muscles. These tests use repetitive nerve stimulation to stimulate a specific nerve multiple times to test muscle fatigue.

Myasthenia Gravis Treatment at Rush

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

Medications

Your doctor will likely discuss with you the pros and cons of various medication options, including the following, as well as closely monitor for any side effects:

• Anticholinesterase inhibitors, provide temporary symptom relief by stopping the body's break down 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 myasthenia gravis and are fast acting.
• Immunosuppressive medications, 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, immunosuppressive medications that are frequently used to treat myasthenia gravis. Steroids such as Prednisone can cause serious side effects, including skin changes (e.g., thinness and discoloration), insomnia and increased risk for developing high blood pressure, diabetes and osteoporosis.

Urgent Therapies

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

• Intravenous immune globulin therapy (IVIg), uses donated blood to provide the body with normal antibodies. IVIg offers short-term benefit.
• Plasmapheresis (also known as “plasma exchange”), 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 offers short-term benefit.

Treatment of Myasthenic Crisis

• Myasthenic crisis is when your muscles become too weak to support breathing on your own and you require a respirator. Myasthenic crisis is an emergency that requires immediate attention.
• Neuromuscular physicians at Rush help patients in the midst of a myasthenic crisis get out of the crisis.
• In addition, they work with you to develop a treatment plan that keeps your condition under control to prevent a crisis.

Thymectomy

• If you have a thymoma or an enlarged thymus, you may be able to achieve remission by having a surgery called thymectomy.
• In certain cases, Rush thoracic surgeons are able to perform this procedure using minimally invasive techniques. These techniques allow the surgeon to remove the thymus through only a small incision in the neck.

Rush Excellence in Myasthenia Gravis Care

• Diagnostic expertise: Neuromuscular physicians have performed thousands of EMG and nerve conduction studies. As a result, they can detect subtle differences in nerves, muscles, and the connections between nerves and muscles. This helps them arrive at a diagnosis with great accuracy.
• Helping you achieve symptom control: Patients with myasthenia gravis can often achieve partial or complete control of their symptoms and return to normal function with the help of neuromuscular specialists. Rush neuromuscular experts are especially skilled at pinpointing the right medicine and dosage for each patient.
• Comprehensive care for co-existing conditions: When you have myasthenia gravis, you are at higher risk of having co-existing conditions. These may include other autoimmune disorders, such as thyroid problems, rheumatoid arthritis, lupus or sarcoidosis. You are also at risk for developing osteoporosis and steroid-induced diabetes from drug side effects. Rush neuromuscular specialists work with other Rush providers to ensure treatment for these other conditions is part of your myasthenia gravis treatment plan.
• Managing your medications: Taking the right medications — and avoiding ones that are harmful for myasthenia gravis — is a big part of achieving control of your symptoms. Rush neuromuscular experts work with you to find the right medications for your needs.
• Minimally invasive thymectomy surgery: Thoracic surgeons at Rush offer minimally invasive thymus removal (known as thymectomy). Minimally invasive techniques typically shorten your length of stay in the hospital and your recovery from surgery.
• Nationally ranked expertise: Neurology and neurosurgery at Rush University Medical Center is consistently ranked among the nation's best by U.S. News & World Report.