Myasthenia Gravis: Autoimmune Muscle Weakness and Its Early Signs

We all know that muscles connect to the bones and joints and help us move by contraction and relaxation. This is regulated by electrical activity using motor nerves. When these muscles get weak and do not function like they are supposed to, it may cause many subtle symptoms which may be easy to dismiss. But, if you notice muscle weakness that worsens with activity and gets better with rest, you should consider talking to a specialist, as you may be dealing with myasthenia gravis- which is an autoimmune condition where immune cells attack muscle cells and their receptors – causing them to not contract or relax at the right time, affecting how you move. Though it is a rare neurological condition, it does affect a few million individuals all over the world, every year, including in the Indian subcontinent.
Types and Causes of Myasthenia Gravis
There are 3 main types- autoimmune, neonatal which affects newborns and congenital where a genetic mutation causes it. Neonatal MG gets better in a few months, as the infant grows. Autoimmune MG can affect your eyes or can cause weakness in other parts of the body.
Symptoms of Myasthenia Gravis
Some of the symptoms you may notice include
- Vision changes- blurry or double vision.
- Ptosis or your eyelids look droopy.
- You may feel really tired all the time.
- Muscle weakness in the arm, hand, legs and neck is prominently felt.
- You may not be able to express yourself with facial cues.
- You may not be able to swallow, talk or chew normally.
- You may even have issues with walking.
For most individuals, feeling energetic first thing in the morning after a good night’s sleep and in turn feeling very tired and spent in the evening is a common problem. In very rare instances, the muscles that regulate breathing may get affected and you may not be able to breathe normally. Then, it is a myasthenic emergency – as signals are being sent to the muscles to help you breathe, but these are not received in the right way.
Diagnosis of Myasthenia Gravis
- Antibody tests are done to check for acetylcholine receptor antibodies- Ach or acetylcholine is a neurotransmitter that regulates muscle movement. When there are too many antibodies, it means these Ach receptors are being attacked brutally by the immune system – which can cause major issues with fatigue and muscle weakness in the long run.
- Another way to diagnose MG is by using imaging- a CT or MRI can check for any thymus gland abnormality.
- An EMG or electromyography is done to check how well your muscles receive signals from nerves by ascertaining how much electrical activity is present.
Myasthenia gravis has different stages-class 1 where only eyes get affected, class 2,3 and 4- where there is progressive muscle weakness and finally class 5 is when you have severe muscle weakness and may have a myasthenic emergency- where you may need a tube to help you breathe.
Treatment of Myasthenia Gravis
You may be recommended certain medications or plasmapheresis – where antibodies from the plasma in your blood are filtered out and donor plasma solution is used to replace blood volume in your body. You may also receive injections or infusions of monoclonal antibodies which can regulate your immune system. IVIG infusions are done over 3-5 days when there is a myasthenic emergency but the best way to ensure you won’t have any long term issues is to get the thymus gland surgically removed.
Cholinesterase inhibitors are medications that can help prevent the breakdown of Ach- to help reduce muscle weakness. Corticosteroids may also be given as they are immunosuppressive in nature.
Conclusion
Though constant movement is hard with myasthenia gravis, you should try to exercise in such a way that your muscle strength improves. You will also have more energy this way. Eating a carbohydrate rich diet can give you more energy, along with good amounts of protein. Try to restructure your day so you can get a lot done in the morning and go for gentler paced tasks in the evening. Taking naps or resting is important too. Try not to go out in the middle of the day- as heat can worsen your symptoms. Though myasthenia gravis is a chronic condition, it can come and go and there may be periods where you have no symptoms. Talk to a specialist for more information about this condition and learn how to manage your symptoms more effectively, by calling for a consultation at KIMS Sunshine hospital.