Symptoms of Myasthenia Gravis: Identifying Common Causes

Myasthenia Gravis Guide: Symptoms, Causes, and Care Tips

Myasthenia Gravis breaks the communication between your nerves and muscles. This chronic neuromuscular disease weakens the voluntary muscles. Patients with this condition often find it difficult to complete even the daily chores, be it standing, lifting objects or speaking. Under this autoimmune condition, the defence system of your body falsely attacks the healthy cells, disrupting routine bodily functions.

To help you understand better, this blog will shed light on every aspect of this disease, from Myasthenia Gravis symptoms to causes.

What is Myasthenia Gravis?

Myasthenia Gravis is the primary reason behind skeletal muscle weakness. These muscles are connected to bones and aid movement. Myasthenia Gravis mostly targets muscles of the face, neck, eyes, arms and legs. The condition can seriously hamper your ability to:

● Blink or open your eyes
● Make facial expressions
● Talk, swallow and chew
● Lift an object
● Walk, run, stand and sit

This condition can occur in people of any age; however, women below 40 and men over 60 are more prone to it.

How Many Types of Myasthenia Gravis Are There?

Myasthenia Gravis disease is categorised into three types. These are:

Autoimmune Myasthenia: Autoimmune Myasthenia occurs due to the increased production of antibodies (immune system proteins). This is the most common of all.
Neonatal Myasthenia: When a foetus receives certain antibodies from the Myasthenia Gravis parent, then it is called the Neonatal Myasthenia. This may result in a weak cry at the time of birth. These Myasthenia Gravis symptoms will eventually disappear after 3 months.
Congenital Myasthenia: Unlike the former 2 types, Congenital Myasthenia is not an autoimmune disease, but an inherited disorder that occurs after birth or in early childhood. The main symptoms of it are weakness and fatigue.

There are two sub-types of the Autoimmune Myasthenia. These include:

Ocular: Ocular Myasthenia is the first step of Autoimmune Myasthenia Gravis. The symptoms begin with drooping eyelids, double vision and weak eyes. In major cases, the Ocular Myasthenia will develop into Generalised Myasthenia.
Generalised: Generalised Myasthenia refers to the weakening of other muscles besides the eyes. Its impact spreads across the face, neck, hands, and legs.

What Are the Myasthenia Gravis Symptoms?

This neuromuscular disorder will affect any muscle that is under your control. Myasthenia Gravis symptoms are different for each muscle. The symptoms may seem mild at first, but they will quickly reach their worst within a few days of the disease commencing. Let's take a look:

Eyes

Ptosis: This includes drooping of one or both eyelids and the inability to keep the eyes open.
Diplopia: It refers to double vision, both horizontally and vertically.

Face and Throat

Dysarthria: Patients experience difficulty in speaking. The speech will sound soft and nasal.
Dysphagia: You will encounter difficulty in swallowing and eating.

Neck and Limb

Due to weakened limb muscles, you will find it hard to hold your head up.

Hands and Legs

Patients will have trouble walking and hand activities.

In the rarest cases, the Myasthenia Gravis symptoms affect the muscles of the respiratory system. You may start experiencing breathlessness and other breathing problems.

What Are the Stages of Myasthenia Gravis?

Based on the severity of Myasthenia Gravis, it is classified into five main stages and various sub-stages. Here is a detailed illustration:

Stages	Substages	Acuteness of Myasthenia Gravis
I		It involves ocular muscle weakness. Other muscles remain normal.
II		In addition to ocular muscles, other muscles experience mild weakness.
	II-A	The weakness predominantly spreads across limb and axial muscles. The oropharyngeal muscles encounter nominal difficulties.
	II-B	This stage mostly involves oropharyngeal and respiratory muscles. The impact on limb and axial muscles remains the same.
III		It involves various muscles and triggers the severity of ocular muscle weakness.
	III-A	It comprises the limb, axial muscles and oropharyngeal muscles to a lesser extent.
	III-B	The severity spreads across the oropharyngeal, respiratory, and axial muscles along with the limb.
IV		This stage increases the weakness severity of affected muscles.
	IV-A	It deals with all the affected muscles: limb, axial, and oropharyngeal muscles.
	IV-B	This stage includes all the affected muscles and the weakness reaches its extreme. Patients may also require feeding tubes without intubation.
V		This final stage involves intubation. Mechanical ventilation is sometimes also required here, except during routine postoperative management.

What are the Causes of Myasthenia Gravis?

Myasthenia Gravis is caused when our body's immune system mistakenly attacks the neuromuscular junction, from where the nerve signals are sent to the muscles. Take a look at the causes of Myasthenia Gravis:

Immune System Attack: Our immune system creates flawed antibodies. They destroy and modify the receptors for acetylcholine at the junction between nerve and muscles.
Thymus Gland Issues: The Thymus gland, an immune system organ, suffers from Thymoma that generates epithelial masses promoting abnormal growth.
Precipitating Factors: Various factors like infections, surgeries, vaccinations, menstruation, emotional stress, pregnancy and postpartum period can trigger Myasthenia Gravis.
Genetic Susceptibility: Genetic susceptibility can also increase the likelihood of getting Myasthenia Gravis.

What Are the Etiological Factors of Myasthenia Gravis?

The factors of the aetiology of Myasthenia Gravis are various. Anyone can be at risk of Myasthenia Gravis if the person has:

A medical history of autoimmune conditions, like lupus and rheumatoid arthritis
Thyroid-related issues.

The symptoms of Myasthenia Gravis start, once you:

Take medication to treat the above-mentioned issues
Underwent a surgery
Suffer from an infection.

How is Myasthenia Gravis Diagnosed?

To diagnose Myasthenia Gravis disease, the physician will ask you questions about the symptoms and your medical history. Then, you will be prescribed a certain physical examination to confirm the diagnosis. These tests are:

Blood Antibody Tests: Most patients of Myasthenia Gravis have a high rate of either acetylcholine receptor antibodies or muscle-specific kinase (MuSK) antibodies in their blood. Therefore, blood antibody tests are a must.
Imaging Scans: MRI and CT Scan help to diagnose the problems with the Thymus gland.
Electromyography (EMG): EMG evaluates the electrical communication between nerves and muscles. It detects the neuromuscular issue precisely.

How to Treat Myasthenia Gravis?

Now that you know the Myasthenia Gravis definition and other aspects of it, it all narrows down to one question, 'Can this condition be cured?' Myasthenia Gravis is a lifelong incurable condition. Fortunately, with the help of surgeries, medicines, and therapies, the symptoms can be managed. Here's a detail:

Anticholinesterase Medications: These medications elevate muscle strength. They improve signals between muscles and nerves.
Immunosuppressants: Immunosuppressants reduce the body's ability to produce abnormal antibodies. These medications may have significant side effects and should only be taken when prescribed by a doctor.
Thymectomy: This surgical process removes the Thymus gland to stabilise the imbalance of the immune system of your body.
Plasmapheresis: This process is also known as plasma exchange. Under this procedure, surgeons remove the plasma, treat all issues and return it to the body.
Intravenous Immunoglobulin: This therapy aims to normalise a compromised immune system. Surgeons inject a pooled antibody solution into the vein to treat a variety of issues including Myasthenia Gravis.
Monoclonal Antibodies: An infusion of lab-created proteins, either intravenous (IV) or subcutaneous (SQ), will be injected to calm down an overactive immune system.

Certain lifestyle changes can also ease your fatigue and enhance your muscle strength:

Exercise regularly
Avoid being sun-burned
Eat a well-balanced nutritious meal
Try to complete all your daily chores as soon as possible
Take a short nap whenever you feel like.

Final Words

Myasthenia Gravis can greatly affect daily lifestyle when left untreated or unmanaged. Therefore, it is important to notice myasthenia gravis symptoms, such as weak muscles, droopy eyes, and trouble speaking, eating, or breathing early on. Getting diagnosed and treated early, with options like medications, therapy, or surgery, can help control the condition well. If you feel constant muscle weakness or tiredness, see a doctor for the best care. With proper care and medications, the symptoms can go down from severe to mild or zero at times.

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FAQ

How common is Myasthenia Gravis in India?

Myasthenia Gravis, a condition that causes muscle weakness, is quite rare in India.

Can a patient recover completely from Myasthenia Gravis?

No. It is a lifelong incurable medical condition; however, the symptoms can be managed using medication.

Does Myasthenia Gravis affect pregnancy?

In some rare instances, pregnancy triggers Myasthenia Gravis symptoms. However, if you are an existing Myasthenia Gravis patient, the symptoms will worsen during the first trimester and childbirth. Ensure to discuss the situation beforehand with your healthcare provider for a safe pregnancy.