What Are Myasthenia Gravis Symptoms & Treatment Options?

Most people with myasthenia gravis can live a relatively normal life with the treatment options available, though it is a long-term health condition. Myasthenia gravis is an autoimmune disorder that usually affects men aged 50 to 80 and women aged 20 to 40. It impairs the communication between nerves and muscles, resulting in muscle weakness. Let’s know about myasthenia gravis symptoms and treatment.

What Are The Symptoms Of Myasthenia Gravis?

Though myasthenia gravis can affect any of the voluntary muscles, it can particularly affect the muscles involved in the eyes, mouth, neck and limbs. Muscle weakness usually worsens when you are active and improves after the rest.

People usually feel stronger in the morning and weaker at the end of the day. Symptoms often reach severity within 1 to 3 years of initial diagnosis.

• Vision problems - Double vision and drooping eyelids, occurs in more than half of people with myasthenia gravis. Around 15 percent of people only have visual symptoms. 
• Difficulty in speaking, which can worsen with an extended speech
• Difficulty in chewing or swallowing. It happens particularly if a lot of chewing is required or toward the end of the meal. People might choke and inhale food particles that can lead to chest infections.
• Difficulty making facial expressions; a smile may look like a snarl
• Difficulty holding or moving the neck up
• Trouble walking
• Weakness in the legs, arms, and fingers. It can cause difficulty in tasks such as climbing stairs, getting up from sitting or lifting objects

In rare cases, myasthenia gravis affects the respiratory system and causes serious breathing problems.

How Is Myasthenia Gravis Treated?

Based on the age, general health, medical history, patient opinion, and disease severity, the physician will recommend a specific treatment for myasthenia gravis.

1. Medications In Myasthenia Gravis Treatment:

Anticholinesterase Medications:

This category of medications is often prescribed initially to treat mild to moderate myasthenia gravis. Pyridostigmine is the commonly prescribed medication of this category. This medication prevents the breakdown of a substance called acetylcholine involved in muscle contraction and helps in the transmission of nerve impulses to muscles. 

The common side effects of this medication are stomach cramps, diarrhea, feeling sick, muscle cramps and twitching. To reduce the risk of food entering the lung passages, you may be asked to take them thirty to forty-five minutes before meals.

Immunosuppressant Drugs In Myasthenia Gravis Treatment:

In people with myasthenia gravis, antibodies produced by the body’s immune system destroy the receptors at the muscles and block the normal communication between the nerve and muscles. Immunosuppressant drugs reduce the immune system activity and prevent the production of harmful antibodies that lead to myasthenia gravis.

1. Steroid medicines:

When anticholinesterase medications do not fully control symptoms, physicians may prescribe steroids. These medications are usually taken along with the anticholinesterase medicines. 

Prednisone is a commonly prescribed steroid in myasthenia gravis. And in cases where prednisone cannot be taken due to health conditions such as liver disorders, other drugs such as prednisolone and methylprednisolone may be prescribed. Long-term use of these medicines may cause side effects such as weight gain, mood swings and increased risk of infections. 

2. Non-steroidal immunosuppressant medicines:

If steroids are not effective in controlling the symptoms, or if patients need a high dose of steroids, a physician may recommend non-steroidal immunosuppressant medicines such as 

• Azathioprine
• Mycophenolate mofetil
• Tacrolimus
• Methotrexate
• Cyclophosphamide
• Cyclosporine

These medications take at least nine months to become effective. So, steroids will be given together with these medicines until these medications start working. Azathioprine is the preferred drug in pregnant patients and older adults, particularly with kidney problems.

The side effects are specific to the type of drug prescribed. Loss of appetite, tiredness, nausea, vomiting, and infections are some common side effects.

3. Monoclonal antibodies: 

• Rituximab
• Eculizumab

These are bioengineered proteins that target specific parts of the immune system. These medications may be used in people with unmanageable myasthenia gravis. Rituximab is particularly effective in people with MuSK myasthenia gravis. They are given as infusions and may be given together with other myasthenia gravis treatments.

While taking immunosuppressant medications, antibodies that help fight infections can also be reduced. So, try to wash hands often and avoid crowded places and people with contagious diseases during the treatment.

2. Surgery (Thymectomy):

Two-thirds of the young people with myasthenia gravis have overactive, enlarged, or tumors in the thymus gland, located in the upper chest. The physician may recommend surgery to remove the thymus, which helps reduce the myasthenia gravis symptoms by altering the immune system. People who are younger than 60 years old and have generalized myasthenia gravis can benefit from this surgery. It can reduce the chance of hospitalization and the need for steroids and immunosuppressant medications. 

3. Emergency Treatment:

When muscle weakness suddenly worsens, and regular medicines don’t work, physicians may recommend these myasthenia gravis treatment options that work quickly to reduce muscle weakness.

IV immunoglobulin (IVIG):

Healthy antibodies (immunoglobulin) pooled from healthy donors will be delivered intravenously over two to five days. It modifies the immune system, and myasthenia gravis symptoms usually get better in less than a week, and benefits may last up to six weeks. 

It may be given until the immunosuppressant medicines start to work. The common side effects are fluid retention, dizziness, chills, and headache. It may also be given before thymectomy surgery or in unmanageable myasthenia.

Plasma exchange (plasmapheresis):

In plasma exchange, your blood is removed through an intravenous line, the harmful antibodies are filtered out, and antibody free blood will return to the body. Myasthenia gravis symptoms get better within a few days, and the benefit may last up to 6 weeks. The common side effects are muscle cramps, low blood pressure, irregular heartbeat and bleeding.

Say No To Myasthenia Crisis:

Myasthenia crisis is extreme muscle weakness, particularly of the respiratory muscles. Serious breathing problems can occur and require urgent treatment in the hospital. Lack of medicines, stress, infections or other factors may cause a myasthenic crisis. 

Taking medicines exactly as prescribed, having proper nutrition, maintaining optimal weight, and balancing periods of activity and rest may help prevent the occurrence of myasthenia crisis.