Myasthenia Gravis

GENERAL INFORMATION:

What is myasthenia gravis? Myasthenia gravis, or MG, is a disease of the nerves and muscles. Normally, when impulses (signals) travel down the nerve, the nerve endings release a chemical substance called acetylcholine. With MG, there is a defect in how acetylcholine is received by the muscle cells. This results in problems in the movement of muscles. Muscles of the eyes, face, neck, arms, and legs are commonly affected by MG. Muscles used in swallowing and breathing may also be affected. MG is most common in young women 20 to 30 years of age, and in men 60 to 70 years of age.

What causes myasthenia gravis? MG is most commonly caused by a problem in the immune system, such as an autoimmune disease. The immune system is your body's defense system against infections and diseases. An autoimmune disease happens when immune cells produce antibodies that attack your own body's cells. Problems in the thymus (gland located behind the breastbone) may also cause MG. Having a family member with MG increases your risk of having this disease.

What are the signs and symptoms of myasthenia gravis? The most common symptom of myasthenia gravis is a painless and worsening muscle weakness. This is usually seen at the end of the day, after exercise, or after a tiring activity. You may also have any of the following:

• Early MG:
  
  
  • Blurred or double vision (eyesight).
    
    
  • Drooping eyelids.
    
    
  • Drooping facial muscles. Sometimes people with MG seem to look like they are wearing a mask. Their faces are flat, without an emotion or expression.
    
    
  • Slurred speech.
  
  
• Later MG:
  
  
  • Fast heartbeats.
    
    
  • Shortness of breath or trouble breathing.
    
    
  • Severe weakness of the arms and legs.
    
    
  • Trouble chewing and swallowing food.

How is myasthenia gravis diagnosed? You may need the following tests:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Computed tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your chest. Your caregivers look at the pictures to check for an enlarged thymus gland. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps caregivers to see the pictures clearly. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Electromyography (EMG): Electromyography is a test that measures the electrical activity of your muscles. Your muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your muscles.
  
  
• Ice test: Caregivers will look for improvement in eyelid drooping after covering your eyelids with ice packs.
  
  
• Magnetic resonance imaging: This test is also called MRI. MRI allows caregivers to see inside your body. During the MRI pictures are taken of your chest. Caregivers use these pictures to look for changes in your thymus gland.
  
  
• Tensilon test: During this test any improvement in your weakness after being given medicine may mean you have MG.

How is myasthenia gravis treated? You may have the following:

• Medicines:
  
  
  • Anticholinesterase medicine: Anticholinesterase is medicine that increases the amount of acetylcholine in your muscles. Acetylcholine is a special body chemical that helps your muscles and nerves communicate (talk to each other) better. It helps you get stronger. You may also take this medicine with steroids. Do not stop taking these medicines without your caregivers OK.
    
    
  • Immune globulins: Immune globulins can be used to treat many different problems. It may be given to help your immune system fight infection. It may also help if your body does not produce enough of certain kinds of blood cells. This medicine may help if your system fights something in your blood or body that it should not. Ask your caregiver for more information about how immune globulin medicine may help you.
    
    
  • Immunosuppressives: These medicines may be given to slow down the immune system. The immune system protects your body from infections and diseases. The immune system may see normal cells as abnormal. These medicines may help keep the immune system from causing symptoms of MG. Do not stop taking these medicines without your caregivers OK. Stopping on your own can cause problems.
    
    
  • Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.
  
  
• Plasmapheresis: This treatment removes unhealthy antibodies from your blood. An antibody is a material made by your body when it tries to fight off infection. A sample of your blood is put in a machine to separate the bad antibodies from red blood cells. The good red blood cells are then put back into your body.
  
  
• Surgery: Surgery may be done to remove your thymus gland. This is to reduce or prevent future symptoms of MG.

Where can I find support and more information? MG is a life-changing disease for you and your family. Accepting that you have MG is hard. You and those close to you may feel angry, depressed, or frightened. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group. This is a group of people who also have MG. Call or write one of the following organizations for more information.

• Myasthenia Gravis Foundation of America
  1821 University Ave W, Ste 5256
  St. Paul, MN 55104
  Phone: 1-651-917-6256
  Phone: 1-800-541-5454
  Web Address: http://www.myasthenia.org
  

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda, MD 20824
  Phone: 1-800-352-9424
  Web Address: http://www.ninds.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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