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Understanding: Ghte D YRI Ghte D

Gravis

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Surender Singh
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15 views

Understanding: Ghte D YRI Ghte D

Gravis

Uploaded by

Surender Singh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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D

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Understanding
Myasthenia
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Gravis
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Jerry, diagnosed in 2002.


What Is Myasthenia Gravis?

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Myasthenia gravis (MG) is a neuromuscular disorder
that causes muscle weakness. It affects muscles that a

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person can usually control consciously. Muscles most
commonly affected are those controlling the eyelids,
eye movement, and breathing and swallowing, as
well as the facial and shoulder muscles. The weakness
tends to temporarily worsen with activity and improve
with rest. MG is an autoimmune disorder. This means
the bodys immune system mistakenly attacks the
connection between the nerve and muscle. In MG, the
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muscle cells have problems responding to the nerve
impulses that normally signal them to contract, and
this results in weakness.
The disease usually does not reduce life expectancy.
Most people with MG manage their symptoms and
lead active lives. MG affects people of all ages and
ethnic groups. Women are most often affected in
their 20s and 30s. Men usually develop MG in late
middle age.
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Transmission of Nerve Impulses to Muscles

Acetylcholine

Nerve Receptor
Cell

Muscle
contraction occurs
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when receptors are stimulated

Normal

Antibody

Muscle
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Reduced
muscle contraction when
receptors are blocked

With Myasthenia Gravis


What Causes Myasthenia Gravis?

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MG is caused by a problem with nerve impulses
getting to muscles. Normally when impulses travel

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down the nerve, the nerve endings release a protein
called acetylcholine. Acetylcholine is like a key that fits
into the acetylcholine receptor, which is like a lock.
With the proper fit, the door is opened and a signal
is sent to the muscle to do its job. Antibodies are
proteins produced by the body in response to harmful
substances. In MG, the body mistakenly makes
antibodies to the acetylcholine receptor. Acetylcholine
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receptor antibodies fit into the receptor and cause it
to be destroyed so the door does not open and no
signal is received by the muscle. This leads to
muscle weakness.
It is thought that the thymus gland may instruct
the immune system to produce the antibodies. The
thymus gland is in the chest. In some people with
MG, the thymus becomes enlarged. In others, tumors
of the thymus may develop.
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In rare cases, children develop MG symptoms due


to a genetic defect. In these children, acetylcholine
antibodies cannot be detected in the blood.
Women with MG who are planning pregnancies
should talk to their physicians. Temporary MG
occurs in about 15 percent of infants born to women
with MG due to transfer of antibodies across the
placenta. The condition lasts for only a few weeks,
but it needs to be recognized. These infants often
need to be treated in an intensive care unit until the
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weakness is gone.
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What Are the Symptoms?

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The symptoms of MG vary from one person to the next.
For some, only the muscles that control eye movements
and the eyelids are affected. In others, the muscles that

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control swallowing and speech are affected. Some muscles
are weaker than others. In some people, breathing can be
affected. This is due to weakness of the throat or diaphragm
muscles. In a few cases, weakness can cause respiratory
failure that requires emergency medical support. In contrast
to many other diseases producing weakness, the legs are less
commonly involved in MG.
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How Is Myasthenia Gravis Diagnosed?
Many disorders can cause weakness. The diagnosis of MG
should be made by a neurologist. The evaluation may include:
Medical and neurologic evaluation
Blood tests to check for antibodies
Blood tests or other studies to rule out other causes
of weakness
Imaging scans
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Electrical tests of nerve and muscle function


(electromyography and nerve conduction studies)
Ice pack test to improve strength of the eyelid

What Are the Treatment Options?


MG does not yet have a cure, but effective treatments are
available. It can take time to find the right combination
of treatments for each person. In up to 20 percent of
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people symptoms may improve or disappear for up to


a year or more. Occasionally the disease may disappear
permanently, although this is rare. No one knows why
these remissions occur.
Treatments include:
Medication
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o Drugs to suppress the immune system and decrease the


autoantibodies
o Drugs that slow the breakdown of acetylcholine and
prolong its action at the nerve-muscle connection
Surgery: The thymus gland should be removed if the
thymus is enlarged on imaging as it could indicate a
tumor. It is still not clear whether removal of a thymus
that appears normal on imaging is a useful treatment.
Plasma exchange: In plasma exchange, abnormal

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antibodies are removed from the blood. Then red blood
cells are returned in artificial plasma. Antibody removal in
this way produces temporary improvement in the majority

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of patients but also requires some form of immune
suppression so that the antibodies do not rebound.
Intravenous immunoglobulin (IVIG): Treatment
involves administering purified antibodies. These
temporarily modify the immune system and provide the
body with normal antibodies from donated blood.

Living with Myasthenia Gravis


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With treatment, the outlook for most people with MG is
bright. You can have a full, productive life.
Learning to manage the symptoms of MG can make it
easier. MG support groups can be a source of help, comfort,
and information. Counseling can help in coping with the
emotional aspects of MG.
People with MG need to plan their activities to conserve
their energy:
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Schedule regular rest periods during the day


Delegate tasks to other family members
Learn to manage and reduce your stress
If your swallowing is affected, plan meals at times when
your muscle strength is greater

Partnering with Your Neurologist


To provide the best care, your neurologist needs to know all
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about your symptoms and medical history. Likewise, you


need to get answers to your questions. Keeping a notebook
about your condition and bringing a few well-organized
questions to your appointments can be helpful.
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Did you know?


Neurologists are medical doctors who specialize in
disorders of the brain and nerves. They are the specialists
who most often diagnose and treat people with
myasthenia gravis.
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For Family and Friends
MG can take a toll on the family, too. If you are

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caring for a family member or friend with MG,
take care of yourself, as well. Avoid the feeling
that you have to do it all yourself. Get help from
family, friends, and professionals. There are many
support groups for caregivers. See Resources for
organizations to contact.
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Help Us Cure Brain Disease
Make a Donation to Research
The American Brain Foundation supports vital
research and education to discover causes, improved
treatments, and cures for brain and other nervous
system diseases. To learn more or to make a donation
to support research, visit www.CureBrainDisease.org.

Make Your Voice Heard


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To keep research advancing toward future cures and


treatments for brain disease, it is important for people
affected by neurologic disorders to advocate for more
research funding. Contact your members of Congress
and ask them to support neurology research by
increasing funding for the National Institutes of Health
(NIH). Look up your Congressional representatives at
www.senate.gov and www.house.gov. Your voice can
make a difference.
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Take Part in Research


People are needed for clinical trials that can help
find new treatments for neurologic disorders. Clinical
trials are research studies. They help ensure that new
drugs are both safe and effective. Ask your neurologist
how to volunteer for a clinical trial. You can also
find trials through patient organizations or the
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American Academy of Neurology website at


www.aan.com/view/clinicaltrials.
Resources

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American Academy of Neurology
www.aan.com/patients
(800) 879-1960

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The American Academy of Neurology website for
patients and caregivers offers a wealth of articles,
information about events and resources, and links to
support groups, clinical trial information, and more.

Neurology Now magazine


www.neurologynow.com
(800) 879-1960
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Free magazine for patients and caregivers, courtesy
of the American Academy of Neurology. Stories about
people living with neurologic disorders, the latest
information on resources and treatments, and more.

American Autoimmune Related Diseases


Association
www.aarda.org
(586) 776-3900
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Muscular Dystrophy Association


www.mdausa.org
(800) 572-1717

Myasthenia Gravis Foundation of America


www.myasthenia.org
(800) 541-5454
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www.aan.com
(800) 879-1960
The American Academy of Neurology, an association of
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25,000 neurologists and neuroscience professionals, is
dedicated to promoting the highest quality patient-centered
neurologic care. For more information about the American
Academy of Neurology, visit www.aan.com.
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Cover photo by Jim Hopwood


2012 American Academy of Neurology Institute

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