Myasthenia Gravis Awareness Month: 4 Things to Know

lazy-eyeJune is Myasthenia Gravis (MG) Awareness Month. So we asked Emory neurologists Taylor Harrison, MD, and Vita Kesner, MD, to share some information about MG.

What is Myasthenia Gravis?

Myasthenia gravis (pronounced My-as-theen-ee-a Grav-us) is a serious neurological disease caused when a person’s immune system is too active and makes antibodies that cause muscle weakness. Antibodies are proteins made by white blood cells and their primary role is to help the immune system recognize and fight bacteria and viruses. In myasthenia gravis, the antibodies affect the ability of nerve signals to trigger the muscles to contract, resulting in muscle weakness. Approximately 15% of patients with myasthenia gravis have weakness that is limited to the face and eye muscles, and 85% have more generalized weakness which can affect speech, swallowing, arm and leg muscles, as well as breathing muscles. The weakness often fluctuates, tending to be better after rest and worse with sustained physical activity. In some people, the weakness remains very mild but it can be disabling or even fatal by causing weakness of breathing muscles.

How is this condition diagnosed and by whom?

A neurologist plays a critical role in both the diagnosis and management of patients with myasthenia gravis. Many people may display symptoms for some time before a final diagnosis is made.

A diagnosis of myasthenia gravis can be confirmed by the presence of antibodies in the blood. There are different types of antibodies that the doctor may look for. The doctor may also evaluate the function of the thyroid gland, because problems with the thyroid can sometimes look like myasthenia and if a patient has myasthenia, than thyroid problems can make the myasthenia worse. Other important tests include electrical testing of the nerves and muscles. A highly specialized test called single fiber electromyography is another test that evaluates whether nerve signals are making muscle cells fire together, and is typically done when there is uncertainty if weakness is indeed related to a diagnosis of myasthenia gravis.

Is the thymus gland connected to an MG diagnosis?

If myasthenia gravis is confirmed, you doctor may order a CT scan of your chest to look at your thymus gland in your chest. The thymus gland is an important organ in the development of the immune system at a very young age, but stops working as you get older and enter the teenage years. A small percentage of patients with myasthenia may actually have a tumor to the thymus gland, which requires surgery. In some patients with myasthenia who have no tumor surgery to take out the thymus gland may be considered, with the idea that the thymus gland is overactive and removal may improve the myasthenia symptoms. The doctor may also order testing of your breathing to make sure the breathing muscles are strong.

What medications are used for treatment?

There are a number of medications used to treat myasthenia gravis, and it is important to recognize that myasthenia gravis is treatable. Medications such as pyridostigmine (MestinonĀ®) is used to help with weakness, it helps the nerve signals get to muscles better. Corticosteroids (e.g., prednisone) and immunosuppressant agents (e.g., ImuranĀ®) may be used to suppress the abnormal action of the immune system that occurs in myasthenia gravis. Intravenous immunoglobulins (IVIg) and plasmapheresis, or plasma exchange, may be especially useful during severe myasthenia gravis weakness. IVIG affects the function or production of the abnormal antibodies and plasmapheresis is a procedure that removes the abnormal antibodies from the plasma of the blood. The best choice of treatment for each patient is determined by a neurologist according to the severity of the myasthenia gravis and other existing medical conditions.

If you suspect you have MG or have been diagnosed and would like a second opinion, you can make an appointment with Emory Neurology by calling 404-778-7777.

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  • Linda Lou McCall

    i am a 65 y/o black female with systemic lupus. About a year ago, I began to notice that my corrected vision was becoming worse. I saw an ophthalmologist in October to see if I had cataracts. His exam was negative but he told me to return in 6 months. I did so in April, with my vision blurry, along with a debilitating fatigue, similar to what I get with severe lupus flare ups every 3 – 5 years. After a visual acuity test, I was diagnosed with ptosis and underwent an upper lid lift on 5/4/15. The post-op result was stunning but my vision was still blurred. After waiting 3 weeks for the surgical swelling to subside, my lid fell right back down again, with the right lid more pronounced. I was sent to a third ophthalmologist whom, after several office tests with ice packs and elevating my lids, ordered a CT scan of my orbit and brain, plus blood tests (ESR, CRO, ANA, ACE, Acetyldroline Receptor Antibody) for myasthenia gravis. All of the test came back normal! Yet the fatigue has become so bad that I can barely get out of bed. My lids are still droopy and my vision is alternately blurred and double. I live in Phoenix but was a resident of metro Atlanta for 15 years. The doctors are talking about another eye lift but that’s not going to address the fatigue and weakness in my legs which is exacerbated by the early high temperatures here. I’m thinking about flying to ATL for a consult at Emory. Can a person have a normal blood testing but still have MG? Could my lupus cause these same symptoms?