Myasthenia Gravis – Diagnosis and Treatment
Diagnosis
Checking Nerves and Muscles
A medical provider examines the patient’s nervous system and muscles. They test for reflexes, muscle tone, strength, touch, vision, balance, and coordination.
This helps spot symptoms like double vision, drooping eyelids (ptosis), and muscle weakness.
Cold Pack Eyelid Test
If a patient has droopy eyelids, a provider may place an ice bag on the eyelid for a few minutes. If the eyelid lifts after the cold treatment, this can suggest myasthenia gravis, especially in people with eye symptoms.
Antibody Blood Tests
Blood tests can detect unusual antibodies, such as acetylcholine receptor antibodies or muscle-specific kinase antibodies. These antibodies affect nerve signals at the neuromuscular junction, making it harder for muscles to work.
| Antibody Type | What It Means |
|---|---|
| Acetylcholine receptor (AChR) | Often seen in myasthenia gravis |
| Muscle-specific kinase (MuSK) | May be present in some patients |
Nerve Signal Fatigue Study
Doctors use repetitive nerve stimulation to check how well nerves work with repeated use. They send small electrical pulses to the muscle and measure any weakness over time.
A drop in muscle strength with repeated stimulation is common in myasthenia gravis.
Single-Muscle Fiber Electrical Test
Doctors use single-fiber electromyography (EMG) to look at electrical activity in individual muscle fibers. If muscle fibers do not respond normally when the nerve stimulates them, this may point to MG.
Scans to View the Chest
Doctors use imaging tests like CT scans or MRIs to look at the thymus gland. Abnormalities such as thymomas or tumors can be linked to myasthenia gravis.
Breathing Function Tests
Pulmonary function tests measure lung strength and capacity. Weak breathing muscles can show that MG is affecting the lungs, leading to symptoms like shortness of breath or trouble swallowing.
Treatment
Medicine Choices
Doctors often start treatment with medicines to improve muscle function or change how the immune system works.
Cholinesterase inhibitors help nerve signals reach the muscles and make movement easier. They do not cure the disease, but they can help some people feel stronger. Common side effects include upset stomach, more saliva, sweating, or diarrhea.
| Group | Purpose | Possible Side Effects |
|---|---|---|
| Cholinesterase inhibitors | Improve nerve-muscle signals | Nausea, diarrhea, sweating |
| Corticosteroids | Suppress immune response | Weight gain, bone loss, infections |
| Immunosuppressants | Weaken immune system response | Infection risk, kidney/liver damage |
Corticosteroids lower the immune system’s attack on the body. They can lessen symptoms, but long-term use can cause weight gain, weaker bones, higher blood sugar, and an increased risk of infections.
Doctors may prescribe immunosuppressants to slow down immune system attacks on nerves and muscles. These medicines may take several months before improvement shows.
Immunosuppressants can raise the chance of infections and may cause liver or kidney problems. Regular checkups and blood tests help monitor for side effects.
Treatments Given Through the Vein
Doctors may give treatments directly into a vein if symptoms suddenly get much worse or before certain surgeries. These treatments often provide short-term relief.
Blood plasma exchange (plasmapheresis) removes harmful antibodies from the blood, much like dialysis. It can improve strength for a few weeks, but finding suitable veins for repeated treatments can be difficult.
Risks include low blood pressure, bleeding, and allergic reactions to the fluids used. Some people may have muscle cramps or irregular heartbeats.
Intravenous immunoglobulin (IVIG) provides healthy antibodies to change how the immune system acts. Improvement usually appears in a week and lasts several weeks. Possible mild side effects include chills, headaches, and fluid buildup.
Doctors may use monoclonal antibody medicines if other treatments have not helped. These drugs can have serious risks, so doctors monitor patients carefully.
Surgery to Remove the Thymus Gland
The thymus gland is part of the body’s immune system. Some people with myasthenia gravis have a tumor called a thymoma, and doctors recommend surgery to remove the thymus (thymectomy) for these individuals.
Even without a tumor, removing the thymus can help control symptoms for some people. Benefits may take a few years to appear.
Types of thymus removal procedures include:
- Open Thymectomy: The surgeon opens the chest to remove the gland, which is the standard approach for large tumors.
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Minimally Invasive Thymectomy: The surgeon makes smaller cuts and uses special tools or cameras, including:
- Video-Assisted Thymus Removal: Uses a thin tube with a camera to see inside the chest and remove the gland through tiny incisions.
- Robot-Guided Thymectomy: Uses robotic arms and a camera, controlled by the surgeon, to perform the surgery through small chest openings.
Minimally invasive methods often mean less pain, less blood loss, and a quicker recovery compared to open surgery.
The type of surgery depends on the patient’s health, the presence of a tumor, and the surgeon’s recommendation.
Ways to Manage Daily Life and Symptoms
People with myasthenia gravis can make practical changes at home to help manage daily activities. Eating at times when muscle strength is best can make meals easier.
| Tip | How It Helps |
|---|---|
| Eat when strongest | Makes eating easier |
| Choose soft foods | Requires less muscle effort |
| Use electric devices | Saves energy |
| Install grab bars and clear floors | Prevents falls |
| Wear eye patch and switch sides | Reduces double vision/discomfort |
Chewing food slowly, taking breaks between bites, and choosing soft foods over tough or chewy foods can help. Safety at home is important. Installing grab bars in bathrooms or near steps adds support.
Keeping floors clear of clutter and moving area rugs can prevent falls. Clearing outside paths and driveways of debris reduces the risk of tripping.
Using electric devices can make daily chores easier and save energy. Electric toothbrushes, can openers, and similar items reduce physical effort.
If double vision is a problem, wearing an eye patch may make activities like reading or watching TV more comfortable. Switching the patch from one eye to the other regularly can minimize eyestrain.
Planning activities for times of peak energy is helpful. Scheduling errands and household tasks during periods of greater strength helps individuals get more done without feeling too tired.
Finding Ways to Manage and Seek Support
Living with myasthenia gravis can be challenging for patients and their families. Managing stress can help, as stress can make symptoms worse.
Simple ways to relax include deep breathing or spending quiet time each day. Ask for help when needed. Learning about the condition empowers both the person with myasthenia gravis and their loved ones.
Support groups offer a chance to meet others with similar experiences and share practical tips.
Getting Ready for Your Visit
Steps You Can Take Before Seeing Your Healthcare Provider
Bringing a friend or family member can help you remember information and provide support. Prepare a list of your symptoms and note when each started.
Write down all medications, vitamins, and supplements you use, including the dosages.
Make a list of questions, such as:
- What could be the reason for these symptoms?
- Which tests might be needed?
- What treatment plan is suggested?
- Are there other options to consider?
- How can other health conditions be managed with this diagnosis?
- Are there activity limits to follow?
Leave space for your own questions—no concern is too small.
Questions Your Healthcare Provider May Ask
Your provider will likely ask about your medical history. They may also ask about your specific symptoms.
These questions might include:
| Question | Purpose |
|---|---|
| Are your symptoms constant or do they come and go? | To check the pattern or triggers |
| How bad are your symptoms? | To understand severity |
| Does anything make your symptoms better? | For clues to possible relief |
| Is there anything that makes things worse? | To identify potential triggers |
If you prepare your answers, you will help your healthcare provider understand your situation. This preparation can also help guide your care plan.
