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Myasthenia Gravis

Cardio-thoracic SurgeryNeurology

Myasthenia Gravis (MG) is a chronic autoimmune disorder characterized by impaired communication between nerves and muscles, resulting in muscle weakness and fatigue. MG can affect any muscle in the body but commonly targets muscles controlling the eyes, face, swallowing, and breathing. Severe cases can be life-threatening.

Symptoms

Eye-related Issues	Drooping eyelids (ptosis) Double vision (diplopia)
Muscle Fatigue and Weakness	Facial muscle weakness, causing stiff or limited facial expressions Difficulty speaking or slurred speech Difficulty swallowing, choking easily while eating Weakness in limbs, difficulty walking or climbing stairs Symptoms typically worsen after activity and improve with rest
Breathing Difficulties (Myasthenic Crisis)	Severe muscle weakness affecting respiratory muscles, potentially life-threatening and requiring immediate medical intervention.

Causes and Risk Factors

Causes

MG is an autoimmune disease where the body's immune system produces antibodies that attack acetylcholine receptors (AChR) at the neuromuscular junction, preventing nerve signals from effectively reaching muscles, resulting in muscle weakness and fatigue.

Risk Factors

It can affect individuals of all demographics, and is more common in women than men.
Women are typically affected between the ages of 20 and 40, men between 50 and 70.
Higher risk for those with other autoimmune disorders (e.g., thyroid disorders, lupus, rheumatoid arthritis).
Slightly increased risk in individuals with a family history of MG, though not typically considered hereditary.

Clinical Evaluation	Detailed patient history and neurological examination to evaluate muscle fatigue patterns.
Blood Tests	Checking for the presence of anti-acetylcholine receptor antibodies (Anti-AChR) or other related antibodies (e.g., Anti-MuSK antibodies).
Electrophysiological Studies	Repetitive nerve stimulation test: Evaluates neuromuscular transmission. Single-fibre electromyography (EMG): A highly sensitive test assessing neuromuscular communication.
Thymus Gland Assessment	Chest imaging (CT or MRI scans) to detect thymus gland abnormalities such as hyperplasia or thymomas, which are associated with MG.

Treatments

Medication:

Anticholinesterase drugs (e.g., Pyridostigmine): Improve nerve-to-muscle communication, relieving symptoms.
Immunosuppressants (e.g., corticosteroids, azathioprine, cyclosporine): Suppress the immune system to reduce antibody production.

Surgical Treatment:

Thymectomy: Surgical removal of the thymus helps improve symptoms and reduce medication dependency.

Short-term Emergency Treatment:

Plasmapheresis and Intravenous Immunoglobulin (IVIG): Used during acute exacerbations or myasthenic crisis for rapid symptom relief.

FAQ

Currently, there is no complete cure for MG, but symptoms can usually be effectively controlled with appropriate treatments, allowing most patients to maintain a good quality of life.

Most patients require long-term medication; however, dosage may be gradually reduced if symptoms stabilize. It is important not to adjust or discontinue medication without medical supervision to avoid disease exacerbation.

Women with MG can typically have normal pregnancies, though symptoms may fluctuate during pregnancy. Close cooperation with healthcare providers is essential for careful management and planning.

With proper treatment, most MG patients have a normal or near-normal lifespan. However, untreated or poorly managed MG, especially involving severe respiratory complications (myasthenic crisis), can be life-threatening.

Patients should avoid excessive fatigue, ensure adequate rest, maintain moderate exercise, avoid hot environments, and follow medical advice regarding medication and regular follow-ups to maintain stable health.