Do you sometimes feel very tired and lifeless as the day goes on? Especially when your eyes feel like they are closing, and it is difficult to talk, eat, or even lift an arm or leg? These things can be more than just fatigue. Today we will talk about Myasthenia Gravis , or (MG) for short, a condition that is a bit complicated, but can be managed well if managed properly .
What is Myasthenia Gravis? Simply put...
Myasthenia gravis is an autoimmune condition. What is it? It's very simple. We have an immune system in our bodies. It's like an army in our bodies. Its job is to protect us by fighting germs and diseases that come from outside. But, sometimes this army makes a little mistake. It thinks that even the healthy cells in our bodies are the enemy. Then it starts attacking those healthy cells. That's what happens in myasthenia gravis.
This mainly affects skeletal muscles . That is, the muscles that are attached to our bones and help us move. Think about it, you raise your hand, blink your eyes, talk, laugh, eat, walk... These muscles help with all of this. In a person with myasthenia gravis, these muscles become weak and lifeless.
The important thing is that this muscle weakness increases when you are working and being active, and decreases when you rest a little . Even if you are fine when you wake up in the morning, as the day goes on and you do your work, you gradually get more tired and your muscles become weaker.
This is a chronic disease, meaning it doesn't go away in a short period of time. But don't worry, there are good treatments to help you control your symptoms and live a normal life .
Why is this happening? What is happening inside our bodies?
To understand this, let's take a small example. Imagine watching a cricket match.
Our nerves are the pitcher. They are the ones who send messages to the muscles.
Our muscles are the catcher. They are the ones who catch the message.
The place where these two exchange messages is called the neuromuscular junction . That's the playing field.
Now, when a nerve needs to send a message to a muscle, the nerve releases a chemical called acetylcholine (this is the ball). Muscles have special places to grab this acetylcholine, called acetylcholine receptors (this is the keeper's glove).
Just like when the ball hits the glove, the muscle contracts, that is, it activates, when the acetylcholine goes and binds to those receptors. This happens very quickly, without any interruption, in a healthy person's body.
But, what happens in someone with myasthenia gravis is that the immune system that we talked about earlier mistakenly destroys or blocks these acetylcholine receptors (catcher's glove) . Then the message (the ball) coming from the nerve cannot be properly caught by the muscle (the keeper). The message exchange happens very slowly, or not at all. That's why the muscles become weak. Do you understand?
Are there different types of myasthenia gravis?
Yes, there are mainly several types:
- Autoimmune myasthenia: This is the most common type. As we discussed earlier, it is caused by a malfunction in the immune system. Although the exact cause of this is not known, it is believed to be caused by the production of certain types of antibodies .
- Neonatal myasthenia: This occurs when a baby receives certain antibodies from a mother with myasthenia gravis during pregnancy. After birth, the baby may have a slightly softer cry and difficulty sucking. However, this is temporary and usually improves after about three months.
- Congenital myasthenia: This is not an autoimmune condition. It is a rare type caused by a genetic change .
There are also two main subtypes of autoimmune myasthenia gravis:
1. Ocular myasthenia: In this, the muscles that move the eyes and raise the eyelids are weakened. The eyelids may droop (ptosis) , or it may be difficult to keep the eyes open. Some people may also see two things (double vision). Often, the first symptom of myasthenia is weakness in the eyes . About half of people with this type of ocular myasthenia will later develop the other type.
2. Generalized myasthenia: In this, in addition to the muscles of the eyes, the muscles of the face, neck, arms, legs, and throat also weaken. It can be difficult to speak, swallow food, raise your arms, get up from a chair, walk long distances, and climb stairs.
What are the symptoms of myasthenia gravis?
Although symptoms can vary, the most common ones are:
- Muscle weakness in the arms, fingers, legs, and neck.
- Very tired (fatigue) .
- Drooping eyelid (ptosis) .
- Blurry or double vision .
- Difficulty showing facial expressions (like not being able to smile properly, making faces).
- Difficulty speaking, swallowing, or chewing . For example, your voice may gradually change as you speak, making you sound like you're speaking in a slurred voice.
- Difficulty walking .
The first symptoms of myasthenia gravis can appear almost suddenly. As we mentioned earlier, your muscles weaken when you are active, and they regain strength when you rest . The severity of this muscle weakness can vary from day to day. Many people feel better at the beginning of the day and are at their weakest at the end.
Very rarely, myasthenia gravis can also affect the muscles of the respiratory system . This can cause shortness of breath or more serious breathing problems. If you feel like you are having trouble breathing, it is an emergency. You should go to the nearest hospital immediately. This usually does not happen all at once.
Who is most at risk for this?
Although myasthenia gravis can develop at any age, it is usually more common in women under the age of 40 and in men over the age of 60 .
You may be at increased risk of developing this condition for the following reasons:
- If you have other autoimmune conditions (e.g. rheumatoid arthritis, lupus).
- If you have thyroid disease .
If you already have myasthenia gravis, some things can make your symptoms worse:
- Some medications for malaria and heart rhythm disorders.
- Undergoing surgery .
- An infection .
What is the relationship between the thymus gland and myasthenia gravis?
Many people with myasthenia gravis have problems with their thymus gland . The thymus gland is a small organ in our upper chest, just below the breastbone. It is part of our lymphatic system. It is the organ that makes white blood cells and helps fight infections.
About two-thirds of people with myasthenia gravis have thymic hyperplasia , a condition in which the thymus gland becomes overactive. In addition, about one in ten people develop tumors in the thymus gland called thymomas . These can be cancerous or benign. It is thought that these abnormalities in the thymus gland contribute to the malfunctioning of the immune system.
What are the possible complications of myasthenia gravis?
The main one is a condition called myasthenic crisis . In this, the muscles that help you breathe become very weak. This may require things like a machine (respirator/mechanical ventilation) to help you breathe. This is a medical emergency that can be life-threatening. It is said that about 1 in 5 people with myasthenia gravis will experience this condition at least once in their lifetime.
In addition, this muscle weakness and fatigue can prevent you from participating in activities you enjoy. It can also lead to stress and depression . However, studies have shown that many people with myasthenia gravis can do light activities and exercise daily.
How do doctors diagnose myasthenia gravis?
If your doctor suspects this after listening to your symptoms and performing a physical exam, they will do several tests to confirm it:
- Blood antibody tests: About 85% of people with myasthenia gravis have abnormally high levels of acetylcholine receptor antibodies in their blood. Another 6% have antibodies to muscle-specific kinase (MuSK) .
- Imaging scans: An MRI (Magnetic Resonance Imaging) or CT scan (Computed Tomography scan) is done to check for problems such as tumors in the thymus gland.
- Electromyography (EMG): This test measures the electrical activity of muscles and nerves. It can detect problems with the communication between nerves and muscles.
Doctors classify myasthenia gravis according to the severity of the disease. There are generally five classes (Class I - V). Class I is a mild condition that only affects the eyes, while Class V is a severe condition that affects breathing, sometimes requiring intubation or mechanical ventilation .
What are the treatments for myasthenia gravis?
There is no cure for myasthenia gravis, but there are effective treatments that can help you manage your symptoms and live a good life.
- Medications:
- Cholinesterase inhibitors / anticholinesterase: These medications work by improving the communication between nerves and muscles, increasing muscle strength.
- Immunosuppressants: Medications like corticosteroids work by reducing the overactivity of the immune system and reducing the production of those wrong antibodies.
- Monoclonal antibodies: These are bioengineered proteins. They are given either as an intravenous (IV) injection or as a subcutaneous (SQ) injection. They control the overactivity of the immune system.
- Plasma exchange / plasmapheresis: A machine removes the plasma from the blood, which contains harmful antibodies, and replaces it with plasma or a plasma solution from a donor.
- Intravenous or subcutaneous immunoglobulin (IV or SQ Immunoglobulin - IVIG or SCIG): Antibodies from donors are given by intravenous (IV) injection over a period of two to five days. This is a treatment for myasthenic crisis as well as generalized myasthenia gravis.
- Surgery: Thymectomy is the surgical removal of the thymus gland. This surgery is recommended for people with a thymoma, as well as for people without a thymus tumor.
All of these treatments can have some side effects, so talk to your doctor before starting any new medication.
What can I do at home to reduce symptoms?
If you have myasthenia gravis, try these things to reduce the fatigue you feel and increase muscle strength:
- Exercise regularly: But only after consulting your doctor, start a safe exercise program that suits you. Exercise strengthens muscles, improves mood, and gives your body energy.
- Avoid going out in very hot weather: Heat can worsen symptoms. When you feel very hot, place a cloth soaked in cold water on your neck and forehead.
- Include plenty of protein and carbohydrates in your meals: They provide extra energy to the body.
- Do the tasks that you find most tiring early in the day: that's when you have the most energy.
- Take a short nap or rest during the day: This will give your body a little rest.
What is the future of myasthenia gravis? (Outlook)
Myasthenia gravis is a treatable disease . Symptoms can range from mild to severe. Symptoms usually reach their peak within one to three years of initial diagnosis.
Many people live full, active lives with treatment.
Sometimes the disease can go into remission . This means that the symptoms disappear for a while. This can be temporary or permanent. If this happens, your doctor will change your treatment plan.
Many people with myasthenia gravis live normal lives . Life-threatening consequences only occur when breathing is affected, such as the myasthenic crisis we discussed.
Myasthenia gravis and pregnancy
Rarely, pregnancy can cause myasthenia gravis symptoms to appear for the first time. If you already have the condition, your symptoms may worsen during the first trimester of pregnancy or after you have your baby. However, in some cases, your symptoms may improve during pregnancy.
Some treatments are not safe during pregnancy and breastfeeding. Therefore, it is important to seek your doctor's guidance during this time to ensure a healthy pregnancy.
When should I see a doctor?
See a doctor if you have these symptoms:
- Blurred vision or double vision.
- Difficulty walking, talking, or eating.
- Severe muscle fatigue or weakness.
- Difficulty breathing.
Remember, if you have trouble breathing, it's an emergency! Call 911 (your local emergency number) immediately or go to the nearest hospital.
What questions should I ask my doctor?
You can ask the doctor questions like these:
- What causes these symptoms?
- What is the best treatment option for me?
- What are the side effects of the treatments?
- What lifestyle changes do I need to make?
- What symptoms should I look out for regarding complications?
- Can I safely start an exercise program?
- Is there a patient support group I can join?
Finally, what to remember (Take-Home Message)
Myasthenia Gravis can be a challenging condition. Even though you want to stay active, you may feel very tired and weak at times. This can affect your mental and physical health over time.
But remember, although there is no cure, with treatment, many people can live full, active lives. Severe disability from myasthenia gravis is rare. Your doctor can suggest ways to manage your symptoms so you can stay well. Don't panic, and don't try to deal with this alone. Follow your doctor's advice and get the help you need. I wish you a speedy recovery!
` Myasthenia Gravis, Myasthenia Gravis, Muscle weakness, Autoimmune diseases, Acetylcholine, Thymus gland, Neuromuscular junction
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