Myasthenia Gravis

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KEY POINTS

• Myasthenia gravis is an autoimmune disease that affects your nerves and muscles.
• There is no cure for myasthenia gravis, but treatment can help you manage your symptoms.
• Take your medicine on an exact schedule. Any delay in taking medicine may leave you unable to swallow or breathe.

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What is myasthenia gravis?

Myasthenia gravis is an autoimmune disease that affects the connections between your nerves and muscles. An autoimmune disease is a disease that causes your body to mistakenly attack your own healthy tissue.

What is the cause?

The immune system is your body’s defense against infection. Antibodies are proteins your immune system makes to help fight infections. When you have myasthenia gravis, your immune system makes antibodies that attack the place where your nerves connect with the muscles. In myasthenia gravis, these antibodies block chemicals that help you move your muscles. This makes your muscles very weak.

The cause of this disease is not well understood. It may start at any age. In women, it happens more often before age 40. In men, it is more likely after age 60.

Rarely, this disease is caused by tumors of the thymus gland. The thymus is a small gland behind your breastbone that helps your body fight infection.

What are the symptoms?

The main symptom is muscle weakness that gets worse with activity and better with rest. Muscle weakness may cause other symptoms such as:

• Eye problems, such as double vision or droopy eyelids
• Trouble speaking, chewing, and swallowing
• Feeling that your head is heavy
• Change in facial expression
• Trouble doing things that use the muscles of your arms or legs, such as climbing stairs or combing hair
• Trouble breathing because of weakness in the chest muscles
• Feeling tired all the time

Symptoms can change from day to day. Stress, infection, or other factors can make symptoms worse. You may have times when you don’t have symptoms (remissions) and then your symptoms make come back (relapses).

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you.

You may have tests such as:

• Blood tests
• Muscle strength test, which uses an injection of medicine (Tensilon) to see if it helps your muscle strength
• EMG (electromyogram), which uses needles passed through your skin to send mild electric signals and check how your nerves and muscles respond

How is it treated?

There is no cure for myasthenia gravis, but treatment can help you manage your symptoms. Treatments may include:

• Medicines to improve muscle strength by helping your muscles get signals from your nerves.
• Steroids or other medicine to keep your immune system from making antibodies. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don't take more or less of it than prescribed by your provider and don't take it longer than prescribed. Don't stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
• Fast-acting medicines to treat your immune system called IVIG or intravenous immune globulin
• Exchanging your plasma, also called plasmapheresis, the fluid part of your blood that contains antibodies, with plasma that does not have these antibodies.
• Surgery to take out part or all of your thymus gland if this is the cause of your myasthenia gravis.
• If your muscles get so weak that you have trouble breathing, you may need emergency medical care and a breathing machine to help you breathe until your muscles are stronger.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• If you are on drug therapy, it is very important to take your medicine on an exact schedule. Any delay in taking medicine may leave you unable to swallow or breathe. You may want to set an alarm clock to remind you to take your medicine.
• Tell all healthcare providers who treat you that you have myasthenia gravis. Some medicines may change the way your MG medicines work. Some medicines can cause you to have severe breathing problems. If you have trouble swallowing or breathing, get emergency treatment right away.
• You should carry an ID card or wear a medical ID bracelet or necklace that says you have myasthenia gravis. If you need emergency care, surgery, or lab tests, this helps the healthcare provider know how to treat you.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Get support. Consider a counselor or talk with family and friends. Join a support group in your area.
• Ask your provider:
  • How and when you will get your test results
  • If there are activities you should avoid
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

For more information contact:

• Myasthenia Gravis Foundation of America
  1-800-541-5454
  http://www.myasthenia.org