Robert Wood Johnson University Hospital

Myasthenia Gravis

Myasthenia Gravis

What is myasthenia gravis?

Illustration of myastenia gravis
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Myasthenia gravis (MG) is a chronic, complex, autoimmune disorder in which antibodies destroy neuromuscular connections. This causes problems with communication between nerves and muscle, resulting in weakness of the skeletal muscles. MG affects the voluntary muscles of the body, especially the eyes, mouth, throat, and limbs.

In the U.S., MG affects about 20 people in 100,000. Women affected by MG generally see onset of the condition by age 20 to 30; the onset of MG in men most commonly occurs after the age of 50. However, MG can occur at any age. Males are more often affected than females.

What causes myasthenia gravis?

Myasthenia gravis is not inherited, nor is contagious. A temporary form may develop in the fetus acquired through antibodies passes to the fetus from mothers with MG. Generally, neonatal forms of MG resolve in two to three months. The disorder generally develops spontaneously later in life as a result of antibodies made in a person's body that attack normal receptors on muscle, to which nerves send impulses. This blocks the chemical released by the nerve endings (acetycholine) from stimulating muscle contraction.

What are the types of myasthenia gravis?

According to the Myasthenia Gravis Foundation of America (MGFA), MG occurs rarely in children. However, there are three types of MG in children, including the following:

MGFA says that, in adults, MG may occur at any age, although symptoms begin to appear more often between the ages of 20 to 30 in women and between the ages of 50 to 60 in men. MGFA estimates that myasthenia gravis is diagnosed in 20 out of every 100,000 people in the U.S.

What are the symptoms of myasthenia gravis?

The following are the most common symptoms of myasthenia gravis. However, each individual may experience symptoms differently. Symptoms may include:

The symptoms of myasthenia gravis may resemble other conditions. Always consult your doctor for a diagnosis.

Exacerbations (worsening of symptoms) and remissions (easing of symptoms) may occur periodically during the course of MG. Remissions, however, are only rarely permanent or complete.

How is myasthenia gravis diagnosed?

The diagnosis of myasthenia gravis is made after the sudden or gradual onset of specific symptoms and after diagnostic testing. During the physical examination, the doctor obtains a complete medical history, and may also ask if there is a family history of any medical problems.

A primary characteristic of MG results in the response of an affected person to certain medications. When given an anticholinesterase medication, such as neostigmine (Prostigmin) or edrophonium (Tensilon), muscle weakness often dramatically improves for a brief time. This provides strong support for the diagnosis of MG.

Other diagnostic tests that may be performed to help confirm the diagnosis of myasthenia gravis include:

What is the treatment for myasthenia gravis?

Specific treatment for myasthenia gravis will be determined by your doctor based on:

There is no cure for MG, but the symptoms can generally be controlled. Myasthenia gravis is a lifelong medical condition and the key to medically managing MG is early detection.

The goal of treatment is to increase general muscle function and prevent secondary respiratory and nutritional problems since the swallowing and breathing muscles are affected by this condition. Most people with MG can improve their muscle strength and lead normal or near normal lives. In more severe cases, respiratory or nutritional support may be required due to breathing or swallowing difficulty.

Treatment may include:

The extent of the problems is dependent on the severity of the condition and the presence of other problems that could affect the individual. In severe cases, a breathing machine may be required to help the person breathe easier.

The health care team educates the family after hospitalization on how to best care for the person at home and outlines specific clinical problems that require immediate medical attention by their doctor. A person with MG requires frequent medical evaluations throughout his or her life.

It is important to allow as much independent function and self-care as possible and to promote appropriate activities to ensure a sense of normalcy.

What is myasthenia crisis?

Myasthenia crisis is a condition of extreme muscle weakness, particularly of the diaphragm and chest muscles that support breathing. Myasthenia crisis may be caused by a lack of MG medication or by other factors, such as a respiratory infection, emotional stress, surgery, or some other type of stressor. In severe crisis, a person may have to be placed on a ventilator to assist breathing until muscle strength returns with treatment.

Precautions, which may help to prevent or minimize the occurrence of myasthenia crisis, include, but are not limited to, the following:

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