Do you sometimes feel like you wake up feeling fine in the morning, but as the day goes on, you feel like you have no energy? It's like your muscles are so weak that you can't do anything, especially your eyes are heavy, and you have difficulty speaking or swallowing food? If you have had such experiences, it is very important for you to be aware of the disease we are talking about today called 'Myasthenia Gravis'. Although this is a bit unfamiliar, once you understand it simply, you can find answers to many questions.
Simply put, what is Myasthenia Gravis?
Myasthenia gravis, or MG for short, is an autoimmune condition . Simply put, it's when our body's own defense system, the immune system, mistakenly attacks parts of our own body. In MG, the immune system attacks the connections between our nerves and muscles.
This causes the muscles that connect to our bones and move us to gradually weaken. This mainly affects:
- For the muscles in your eyes, face, neck, arms, and legs.
This weakness may make it difficult for you to do things like:
- Move your eyes around, blink.
- Keep your eyes open.
- Express different emotions with your face.
- Chew food, swallow, and talk.
- Raise your hands, lift your things.
- Climb a flight of stairs, get up from a chair.
The most unique and important feature of this disease is that these muscle weakness increases when you are active, but they come back to life after a short period of rest.
This is a chronic condition. That means there is no one-size-fits-all cure. But don't worry, with today's highly effective treatments, anyone can manage their symptoms and live a healthy life.
Are there main types of myasthenia gravis?
Yes, there are several main types of this condition. Let's see what they are.
| Disease type (Type) | Brief Explanation |
|---|---|
| Autoimmune Myasthenia | This is the most common type. It is caused by certain antibodies produced by the body's immune system. The exact cause is not clear. |
| Neonatal Myasthenia | A temporary condition caused by the baby receiving antibodies from a mother with MG during pregnancy. At birth, the baby may cry weakly and have difficulty sucking. These symptoms disappear after about three months. |
| Congenital Myasthenia | This is not an autoimmune condition. It is a rare condition caused by a genetic change. |
The most common autoimmune myasthenia gravis condition is further divided into two main types.
Ocular Myasthenia
This is a condition where only the muscles that move the eyes and eyelids become weak. This can cause your eyelids to droop or make it difficult to keep your eyes open. Some people may also experience double vision. This eye weakness is often the first symptom of MG. About half of people with this condition will eventually develop generalized vision.
Generalized Myasthenia
In this condition, in addition to the muscles of the eyes, the muscles of the face, neck, arms, legs, and throat also weaken. This can make it difficult to speak, swallow food, raise your arms above your head, get up from a sitting position, walk long distances, and climb stairs.
How does this disease actually develop? What happens inside our bodies?
To understand this, let's take a small example. Imagine that the relationship between our nerves and muscles is like that between a pitcher and a catcher in a cricket match.
1. The bowler (nerve): The nerve is what sends the message to the muscle to "contract".
2. The ball (Acetylcholine): This message is sent through a chemical (neurotransmitter) called 'acetylcholine'. This is our 'ball'.
3. The fielder's glove (receptors): There are special places on the palm to catch this 'ball'. We call them 'receptors'. This is like the fielder's 'glove'.
Normally, the 'ball' (acetylcholine) sent from the nerve matches up with the 'glove' (receptor) in the muscle. That's when the muscle receives the signal to contract. This happens very quickly, without any interruption.
However, something different happens in the body of someone with myasthenia gravis.
Their immune system makes the wrong antibodies and blocks or destroys the receptors in the muscle. Then, even though the nerve sends the ball, there's no glove to catch it. So, the muscle doesn't get the right signal, so it weakens. When you work hard, the muscle becomes even weaker because it can't catch the ball. When you rest, you can use the glove again a little bit, so it comes back to life. Do you understand?
What are the main symptoms of myasthenia gravis?
Symptoms of MG can start suddenly. They can also vary in intensity from day to day and from time to time. Many people feel stronger at the beginning of the day and weaker at the end of the day.
| Symptom | Explanation |
|---|---|
| Drooping eyelid (Ptosis) | Drooping eyelids in one or both eyes. This is the most common early symptom. |
| Blurred or double vision | Double vision can occur due to weakness of the muscles that move the eyes. |
| Difficulty speaking, swallowing, or chewing | Things like a change in voice when speaking, difficulty swallowing, food getting stuck, and difficulty chewing may occur. |
| Weakness in the arms, legs, and neck | Hands get tired easily when lifting, combing hair, brushing teeth, etc. Difficulty walking, difficulty holding head up straight. |
| Change in facial expression | Not showing the same facial expression as usual when smiling, can make you look like you're "forcing a smile." |
| Difficulty breathing | This is a very dangerous and urgent condition. If you experience shortness of breath due to weakness of the breathing muscles, you should immediately go to the Emergency Department (ETU) of a hospital. This is called a 'Myasthenic Crisis'. |
How does the doctor diagnose this disease exactly?
If you have these symptoms, your doctor will first ask you about your medical history and perform a physical exam. They may then order several tests to confirm the diagnosis:
- Blood tests: Your blood will be checked for the abnormal antibodies we talked about earlier (`acetylcholine receptor antibodies` or `MuSK antibodies`). About 85% of people with MG have these antibodies in their blood.
- Imaging scans: A CT or MRI scan may be done to check for a problem or tumor (thymoma) in your thymus gland.
- Electromyography (EMG): This is a somewhat specialized test that looks for any abnormalities in the way electrical signals are transmitted between nerves and muscles.
Based on the results of these tests, your doctor will determine the stage of your condition and recommend the most appropriate treatment plan for you.
What are the treatments for this?
First of all, MG is a treatable condition. While there is no cure, there are many effective treatments available today that can help you manage your symptoms and live a normal, active life.
There are several treatment methods:
- Medications:
- Drugs like `cholinesterase inhibitors` improve the transmission of signals between nerves and muscles, increasing muscle strength.
- Immunosuppressants, such as corticosteroids, reduce the production of those abnormal antibodies.
- Monoclonal antibodies: These are special proteins given intravenously. They control the activity of the immune system.
- Plasma exchange (Plasmapheresis): This involves connecting you to a special machine that removes the plasma portion of your blood that contains harmful antibodies and replaces it with healthy plasma or a solution.
- IV immunoglobulin (IVIG): An intravenous infusion of antibodies from healthy donors. This helps to suppress the immune system.
- Surgery: For some people, especially those with a thymus tumor, the gland is surgically removed (a `thymectomy`). This can significantly control symptoms.
Your doctor will choose the most appropriate treatment for your condition.
What can we do for ourselves while living with symptoms?
While undergoing treatment, making small changes to your lifestyle can make living with this condition much easier.
- Exercise: Ask your doctor and engage in light exercise that is appropriate for you . This will strengthen your muscles, relax your mind, and give you energy.
- Avoid heat: Extreme heat can worsen symptoms. So avoid going out in the hot sun during the day. When you feel hot, place a cloth soaked in cold water on your neck and forehead.
- Good nutrition: Eat a balanced diet rich in protein and carbohydrates to stay energized.
- Plan your work: Do the tasks that require the most effort when you have the most energy, which is in the morning.
- Rest is essential: Take short breaks throughout the day. Get some sleep. Listen to your body. Don't force yourself to work when you feel tired.
Take-Home Message
- Myasthenia gravis (MG) is a condition caused by a malfunction in our own immune system, but it can be effectively treated .
- If you experience symptoms such as drooping eyelids, blurred vision, difficulty speaking or swallowing, or unusual fatigue that increases throughout the day, see a doctor without delay.
- If you experience any difficulty breathing, go to a hospital's Emergency Department (ETU) immediately, as it may be a medical emergency (myasthenic crisis) .
- With the right treatment, following your doctor's advice, and making simple lifestyle changes, most people with MG can live full and active lives . There's no need to be afraid.
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