Myasthenia gravis (MG) can affect people of any age. It is an autoimmune disorder, which leads to the weakening of the muscles that control voluntary actions. This condition mostly affects the eyes, mouth, throat, and limbs. It is a lifelong condition that keeps progressing and getting worse. It is necessary to get the treatment, which will slow down its progression.

According to the National Institutes of Health, the causes of myasthenia gravis are:

Antibodies –Myasthenia gravis is caused because of the poor transmission of the signals between the nerves and muscles. The place where the nerve cells interact with the muscles, they control is called the neuromuscular junction. When the signal transmission at the junction is interrupted, this can potentiate the risk of myasthenia gravis.

For voluntary action, the brain cells and neurons communicate with the help of neurotransmitter chemicals known as acetylcholine, and the information is passed to the target muscles through the release ofacetylcholine chemicals between the nerve cells and muscles. These chemicals bind to the sites, which are called acetylcholine receptors on the muscle. This causes the muscles to contract, and this is how the brain controls the voluntary action by signaling it to the muscles.

However, people with this condition suffer due to the weakening of these muscles. This happens when the acetylcholine receptors of the muscles do not receive the signals from the nerve cells. The immune system of MG-affected people destroys these binding sites on the muscles by releasing antibodies. Therefore, antibodies released by the immune system damage the acetylcholine receptors and prevent signal transmission, which leads to the weakening of the muscles.

Thymus gland – Thymus is a small gland in the lymphatic system that is present in the chest between the lungs. It is a part of your immune system, and it produces white blood cells (lymphocytes), also known as T-cells. T-cells support your immune system to effectively fight off any infection or disease and keep your body safeguarded against any illness.

Some studies revealed that, in people with MG, this gland is a bit larger than its usual size and it can affect the signal transmission between the nerve cells and the muscles. This gland might produce white blood cells with erroneous instructions, which makes the immune system destroy its own T-cells and produce antibodies in large amounts. These antibodies block the signal transmission at the neuromuscular junction, which causes the muscles to lose their strength.

 Mother-to-child – A pregnant woman having this disease might transfer the antibodies to the developing fetus, which potentiates the risk of myasthenia gravis in the developing fetus. The antibodies might enter the placenta and the fetus. The baby might be weak and develop breathing problems. They may take a few months to recover, as the symptoms are generally temporary.

Emotional stress – Various studies have concluded that acute emotional stress can contribute to the worsening of the symptoms of myasthenia gravis. It can also trigger a myasthenia crisis that may arise when the muscles that are responsible for controlling your breathing function get severely damaged. Myasthenia crisis is a condition that is characterized by respiratory failure and as a result, the person requires mechanical ventilation for breathing.

Respiratory infection – Infections related to the respiratory tract are common contributors to myasthenia gravis deterioration. MG patients need to be careful, as respiratory tract infection can exacerbate the condition and the consequences can turn severe.

 Surgical procedures – Surgery can increase the possibility of myasthenia crisis. The person suffering from myasthenia crisis requiresintensive care and mechanical ventilation.

 Medications – The side effects of certain medications and drugs can induce the deterioration of myasthenia gravis. People having this disease must avoid taking medications certain types of drugs to prevent the exacerbation of their condition. Some drugs that need to be avoided during MG are antibiotics, beta-blockers, anesthetics, quinine gluconate, quinine, phenytoin, etc.

Diagnostic tests

According to the Mayo Clinic website, your healthcare provider will check your symptoms to confirm whether you are experiencing myasthenia gravis. They will ask you about your medical history and conduct your physical examination. They may suggest a combination of tests to identify the cause of this chronic condition. The tests may include:

• Neurological examination – The healthcare provider will check your muscle response by testing your muscle strength, sensitivity to light or touch, balance, coordination, reflexes, and muscle tone.
• Blood sample tests – These tests will reveal the type of antibodies that affect the neuromuscular junction sites.
• Ice pack test – This test is done to analyze your eye’s muscle response to the stimulus of ice.
• Imaging – These are scanning tests done by CT scans and MRIs.
• Repetitive nerve stimulation – This test analyzes whether your muscles are receiving signals from the nerve cells. It involves the use of electrodes that are attached to your skin over the muscle that needs to be tested.
• Single fiber electromyography (EMG) – This involves the insertion of a thin wire electrode into the muscles by piercing the skin. This test checks whether the brain is able to send signals to the muscles.
• Pulmonary function tests –It is done to see if the condition is causing or going to cause breathing problems.

A combination of these tests will help your healthcare provider to rule out the treatment appropriate to your condition.

In general, the primary cause of Myasthenia gravis is the interruption of signal transmission between the nerve cells and the muscles. The muscles receive erroneous signals from the nerve cells, which impair their voluntary function. It is a chronic condition, that is progressive in nature and is incurable.

This condition affects the voluntary muscles, that is, the muscles that control the eye movements, mouth, throat, and limbs. The brain fails to control these muscles, which leads to their weakening and impairment of their function. The muscles of the person with this condition may get tired too soon because of their weakening.

How do the muscles lose their strength?

The neurons in your brain release neurotransmitters, which are chemical messengers that carry the signal from the brain to the muscles. The communication between your brain cells and neurons is established with the help of a neurotransmitter known as acetylcholine. This release of this chemical at the junction of the nerve cells and muscles signals the muscles to respond.

The muscles have receptor sites for acetylcholine chemicals. When nerve cells release acetylcholine, the chemical binds to the acetylcholine receptor sites in the muscles. And this is how the muscles respond to the brain’s commands to perform voluntary action.

In the case of Myasthenia gravis, these acetylcholine receptor sites on the muscles get destroyed due to some factors, and as a result, the muscle fails to receive the signals from the nerve cells. Instead, the muscles receive some incorrect signals, which affects their function and causes them to lose their strength.

Factors that lead to muscle weakening

There are various factors that can contribute to the exacerbation of muscle control, but the main reasons for Myasthenia gravis are given below:

Antibodies – The acetylcholine receptor sites present in the muscles receive some erroneous signals from the nerve cells. Since myasthenia gravis is an autoimmune disorder, the condition can be attributed to immune system action. The immune system releases anti-acetylcholine receptor antibodies, which destroy the acetylcholine receptor sites on the muscles and prevent the signal transmission to the organs.

Due to the lack of proper signal transmission, the muscle may act up and become completely weak. The organ corresponding to the affected muscle may fail to respond voluntarily.

Thymus gland – This gland is present in your chest just between your lungs. It forms a part of your immune system and is responsible for producing white blood cells or lymphocytes. Lymphocytes support your immune system in fighting infectious pathogens or foreign elements and preventing and protecting your body against any infection or disease.

In some people, this gland might grow bigger in size, and it may produce lymphocytes with incorrect instructions. These lymphocytes might trigger the release of anti-acetylcholine receptor antibodies which attack the acetylcholine receptor sites on the muscles and hinder signal transmission. This majorly affects muscle function.

Symptoms

The condition might become worse when you use the affected muscles repeatedly without letting them rest. Resting is essential for weak muscles, as it helps in restoring some strength in them. As the condition progresses, the symptoms might turn more severe, and resting time has to be increased correspondingly.

Certain muscles that control voluntary movements are affected in this condition. This condition commonly impairs the function of the following muscles:

• Eye muscles – When these muscles become weak, the eyelids of one or both eyes become droopy. This condition is known as ptosis. Another symptom of this condition is double vision, called diplopia, wherein the person sees two images of an object.
• Face muscles – The impairment of these muscles leads to a change in facial expressions.
• Throat muscles – When throat muscles get affected, the person experiences difficulty in speaking, chewing, or swallowing. This might increase the risk of choking. Also, they might require a long time to chew as they might get tired halfway.
• Neck muscles – The person may not be able to keep their neck straight or hold their head up for long.
• Limb muscles – This makes the movements of arms and legs difficult. The person may have trouble while walking.

Factors that worsen the condition

• Stress – Stress can deteriorate the symptoms even more. It can trigger physiological and hormonal changes in the body, which can make the condition worse.
• Infection – Since myasthenia gravis is an autoimmune disorder, the introduction of any infectious pathogen can require immune system action. This can contribute to the worsening of the condition.
• Surgery – Surgical procedures can increase the risk of myasthenia crisis, which may require the person to be put on mechanical ventilation and intensive care.
• Medications – The side effects of certain medications and drugs can potentiate the risk of worsening of the condition.
• Pregnancy – During pregnancy, the female goes through tremendous physiological and psychological changes. This can cause exacerbation of the condition.

Myasthenia gravis (MG) is generally an autoimmune disorder that causes the weakening of the skeletal muscles. It is a chronic condition, which weakens the muscles by hindering communication between nerves and muscles. This condition usually affects the voluntary muscles of the body, especially the muscles that control the movement of the eyes, and muscles that are present in the mouth, throat, and limbs.

Symptoms of Myasthenia Gravis

This disorder targets the voluntary muscles of the body. When that weak muscle is used, it can exacerbate the condition. It is a progressive condition, which may go away for some time and reappear. This might keep happening again and again. After adequate resting of the muscle, the person may feel relief for some time.

As the condition mostly affects the muscles in the eyes, throat, mouth, and limbs, it can make it difficult to swallow or breathe. Some common symptoms of this chronic disease are as follows:

• Heaviness in the eyelids or droopy eyes.
• Double vision, known as diplopia.
• Blurred vision.
• Difficulty with chewing and swallowing.
• Speech impairment.
• Weakness in neck or limbs.
• Shortness of breath.
• Changes in facial expressions.

Muscle weakness might worsen with each passing day, and if the person does not take enough rest, then the condition can become severe. Resting can be helpful in restoring muscle strength, as it gets to recharge itself during the resting period.

Causes of Myasthenia Gravis

According to the different studies, the factors that can lead to this chronic disease are:

Antibodies –For voluntary action to happen, the receptors of the muscles must receive the signals from the nerves present in your brain. The brain releases chemicals, known as neurotransmitters, which carry the signal to the receptor sites in the muscles.

In the person affected with myasthenia gravis, the immune system releases antibodies that damage the muscle receptor sites and prevent the transmission of signals from the brain. As the muscles fail to get the signal, the muscles remain non-responsive to the brain’s signals. This causes the weakening of the muscles.

Thymus gland

This gland is present in the chest, between the lungs. It is a part of the immune system and is responsible for making white blood cells (WBCs), called lymphocytes, which protect your body from infectious pathogens. The thymus also produces antibiotics and in myasthenia gravis patients, it is quite larger in size than usual.

As per the National Institutes of Health, in myasthenia gravis patients, this gland might interfere with the neurotransmitter action. It may block the muscle receptor from receiving the signals for developing immune cells. However, it sends wrong signals instead, which causes the immune system to attack its own cells and tissues and produce acetylcholine receptor antibodies to destroy the neuromuscular transmission.

Myasthenic crisis – This is a condition that arises when the muscle that supports and controls your breathing function gets severely damaged. It is a crisis situation as the patient needs ventilator support for breathing.

Factors that contribute to the worsening of Myasthenia Gravis

• Stress – Some studies revealed that people with stress and depression disorders experience intense symptoms due to muscle damage. Mental health disorders like stress, depression, and anxiety can exacerbate the condition.
• Fatigue – It is quite common among people with MG. They lack the motivation to do physical exercise and prefer a sedentary life. This can lead to loss of muscle strength even more.
• Illness or infection – MG can get triggered due to infections. This happens because the immune system is already weak and if some infectious pathogens enter your body, it can make it even worse.
• Surgery – Exacerbation of MG can happen after some surgical procedures too.
• Pregnancy – The condition worsens as the females gain weight during pregnancy and tend to be more fatigued.
• Medications – Side effects of certain medications can make it worse. Such medications include antibiotics, anesthetics, beta-blockers, quinine gluconate, quinine, phenytoin, etc.

Who is more likely to develop this disease?

According to the National Institutes of Health, this disorder can arise in people regardless of age. However, it is quite common and more frequently seen in females who are younger than 40 and males who are above 60. This condition is not contagious, and it does not even run in the family. The factors that cause this disease have nothing to do with inheritance.

Rarely, this disease might get passed on from a mother to the developing baby in the womb. Babies of females diagnosed with MG are more susceptible to the condition. The antibodies produced by the mother’s body may enter the placenta and affect the baby. This can make the baby very weak, and they may have difficulty sucking, and breathing.

Diagnosis and treatment

The healthcare provider will conduct your physical examination and ask you some general questions regarding your medical history and symptoms and their duration, etc. Further, they will suggest some tests to check your neurological health and response. Based on the diagnostics tests, they will prescribe some appropriate treatment, which might include – medications, therapies, or surgery.

A chronic condition like myasthenia gravis (MG) cannot be cured as it is a life-long medical condition, but it can be managed very well. It is an autoimmune disorder that impairs the function of voluntary muscles. Its early detection reduces the risk of complications. Reversal of this condition can be done by implementing some positive lifestyle changes and getting timely treatment.

This disorder affects the muscles, which gives rise to difficulties with breathing and swallowing. If the condition becomes severe, the person may develop serious issues with breathing and swallowing, and hence they will require some external support for both these functions.

In combination with the treatment, it is necessary to cultivate some habits, which will prevent the worsening of the disease by slowing down its progression. According to the Mayo Clinic website and some other sources, several habits that can help manage the condition are as follows:

Make changes in your mealtime routine.

Due to the weakness in the muscles, your ability to chew and swallow food might be majorly affected. These difficulties can be managed by making some changes and some adjustments to your eating routine. If you feel your muscles are weak then switch your mealtime to the time when your muscles are strong, and you can chew the food.

You can eat small portions of meals several times a day, rather than taking a big meal. This will make it easier for muscles. The muscles will not get overworked and remain strong. Also, make sure you eat something soft and easy to chew, in this way, there will be less strain on your muscles.

Take rest breaks several times a day.

Resting is essential for myasthenia gravis patients. It is a kind of restorative activity for your muscles, as it allows the muscles to become relaxed and recharge. After a period of resting, the muscles might be able to perform better. The most important thing is nighttime sleep. You need to prioritize your sleep.

Besides, take some naps by planning and scheduling snooze sessions in the daytime.Identify the time of the day when your muscles are most active and schedule your tasks according to that. Practice stillness and mindfulness and sit in silence for a while.

Make use of tools to ease your work.

You can preserve your energy with the help of tools and electrical appliances. For example, to increase your comfort you can use a dishwasher machine instead of doing the utensils with your hands, get an electric toothbrush, use a vacuum cleaner, take support of a walker or wheelchair, and so on. These automatic appliances will help you to increase your comfort.

Let your eyes relax.

Long screen time can lead to the weakening of your eye muscles. Those who work for long hours on screen might experience strain in the eye muscles. It is necessary to reduce screen time and give your eyes some rest. In case you have double vision, which is a symptom of MG, you must use an eye patch to cover one eye. It will reduce eyestrain.

Seek help and support.

Your disability might not be understandable by everyone unless you let them become aware of your difficulties. Most people may have no idea what MG is. You have to talk to them and tell them about the condition and how some tasks and activities are physically draining for you. In this way, you can make adjustments and someone else can replace you.

What are the symptoms of Myasthenia Gravis?

The symptoms of this disorder can be managed with the help of medications or other treatments and lifestyle changes. The condition affects the function of voluntary muscles of the body. The muscles that get impaired are eye muscles, muscles of the throat or mouth, and limbs. The worsening of this condition can give rise to serious difficulties with breathing, chewing, and swallowing.

When the muscle is used excessively, it can become very weak. Since MG is a chronic condition, it gets worse with time. These difficulties might suddenly become worse and sometimes they might be alleviated on their own. The way to prevent these difficulties is through resting. The muscles can get reenergized by resting. Some common symptoms of this condition are listed below:

• Heaviness in the eyelids or droopy eyes.
• Blurred vision.
• Double vision, called diplopia.
• Difficulty with chewing, swallowing, and breathing.
• Speech impairment.
• Weakness in neck or limbs.
• Shortness of breath.
• Changes in facial expressions, for example, a smile can look like a snarl.

Diagnostic tests and treatment

Treatment and lifestyle factors both are necessary to manage the condition and reverse its progression. Your healthcare provider will perform diagnostic tests, wherein they will analyze your neurological health, order blood sample reports, and conduct several other screening tests for confirmation. They will suggest some appropriate treatment, which can bed one with the use of medications, but in some cases, the person might need therapies and even surgeries.