Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by weakness and rapid fatigue of the voluntary muscles. The name “myasthenia gravis” comes from Latin and Greek, meaning “grave muscle weakness.” This condition is caused by an abnormal immune response that interrupts the communication between nerves and muscles.

Things are not always black and white. I know of one person who has the symptoms but does not mark all of the check boxes for symptoms and so therefore does not have it. The doctors insist she has Parkinson’s, but she does not have all of those symptoms either.

How to Identify Myasthenia Gravis

Symptoms:

• Muscle Weakness: The most common symptom of MG is muscle weakness, which worsens with activity and improves with rest.
• Eye Problems: Drooping of one or both eyelids (ptosis) and double vision (diplopia) are often early signs.
• Facial and Throat Muscle Weakness: Difficulty swallowing, chewing, speaking, and making facial expressions.
• Limb Weakness: Weakness in the arms, hands, fingers, legs, and neck can also occur, making daily tasks challenging.
• Breathing Difficulties: In severe cases, the muscles that control breathing can become weakened, leading to a life-threatening condition known as a myasthenic crisis.

Diagnosis:

• Clinical Examination: A neurologist will assess muscle strength and look for signs of fatigue after repeated use of a muscle.
• Blood Tests: Detecting the presence of abnormal antibodies, such as acetylcholine receptor antibodies (AChR-Ab) or muscle-specific kinase antibodies (MuSK-Ab).
• Edrophonium Test: This involves administering a drug called edrophonium, which temporarily relieves muscle weakness in people with MG.
• Electromyography (EMG): Measures the electrical activity of muscles to assess their function.
• Imaging: A chest CT or MRI scan can identify an abnormal thymus gland, which is associated with MG.

History of Myasthenia Gravis

• Ancient Observations: While MG as a distinct condition wasn’t described until the 17th century, muscle weakness has been documented in ancient texts, though not specifically attributed to MG.
• 17th Century: The first recognizable descriptions of MG-like symptoms appeared in medical literature, but understanding of the condition was limited.
• 19th Century: In 1877, British physician Samuel Wilks documented a case of muscle weakness resembling MG.
• Early 20th Century: In 1934, Mary Walker discovered that an injection of physostigmine (a drug that inhibits acetylcholinesterase) temporarily improved muscle strength in MG patients, linking the condition to neuromuscular transmission.
• 1950s: The autoimmune nature of MG was established when researchers identified that the body’s immune system was attacking the acetylcholine receptors at the neuromuscular junction.
• 1960s-1970s: The role of the thymus gland in MG was recognized, leading to the practice of thymectomy (removal of the thymus) as a treatment.
• Modern Era: Advances in immunology and neurology have led to a better understanding of the disease and the development of targeted therapies.

Treatments for Myasthenia Gravis

There is currently no cure for MG, but various treatments can manage symptoms and improve quality of life.

Medications:

• Acetylcholinesterase Inhibitors: Drugs like pyridostigmine (Mestinon) increase the levels of acetylcholine at the neuromuscular junction, improving muscle strength.
• Immunosuppressants: Medications like prednisone, azathioprine, and mycophenolate mofetil suppress the immune system’s attack on the acetylcholine receptors.
• Plasmapheresis: This procedure removes antibodies from the blood, providing temporary relief of symptoms.
• Intravenous Immunoglobulin (IVIG): Provides normal antibodies to alter the immune system’s response.

Surgical Treatments

• Thymectomy: The surgical removal of the thymus gland can lead to symptom improvement or even remission in some patients. The thymus is often abnormal in MG patients and plays a role in the autoimmune response.

Lifestyle Adjustments:

• Rest: Frequent rest periods can help manage fatigue.
• Avoiding Triggers: Stress, infections, and certain medications can worsen symptoms, so it’s essential to avoid these when possible.
• Supportive Therapies: Physical therapy, occupational therapy, and speech therapy can help maintain muscle function and quality of life.

Emerging Treatments:

• Monoclonal Antibodies: Drugs like eculizumab (Soliris) and rituximab are newer treatments that target specific parts of the immune system.
• Gene Therapy and Stem Cell Therapy: Research is ongoing in these areas, with the hope of developing more effective and potentially curative treatments in the future.

Conclusion

Myasthenia Gravis is a complex and challenging condition, but with early diagnosis and appropriate treatment, many people with MG can lead active and fulfilling lives. The ongoing research offers hope for even more effective treatments and possibly a cure in the future. Understanding the history and development of treatments for MG underscores the progress made in managing this once-mysterious condition.