Myasthenia Gravis Treatment in Indore

Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disorder that causes weakness in voluntary muscles.

It occurs when the immune system produces antibodies that interfere with acetylcholine receptors at the neuromuscular junction, preventing normal nerve-to-muscle communication.

MG can affect any voluntary muscle, most commonly those controlling:

Eyes and eyelids

Facial Expressions

Chewing and swallowing

Neck and limb movements

Muscle weakness in MG worsens with activity and improves with rest.

Causes & Risk Factors

1. Autoimmune Dysfunction

Autoantibodies attack acetylcholine receptors (AChR) or associated proteins like MuSK, impairing neuromuscular signalling.

2. Thymus Abnormalities

MG is associated with a tumour of the thymus-thymoma-or thymic hyperplasia.

3. Genetic Predisposition

Rarely familial; most are sporadic autoimmune diseases.

4. Environmental Triggers

Infections, stress, or certain medications can exacerbate the symptoms.

How MG Affects the Body-Mechanism

Antibodies bind the acetylcholine receptors of the muscle cells.

Nerve impulses fail to effectively trigger muscle contraction.

Repeated use of muscles results in progressive weakness.

Rest only temporarily restores strength, while prolonged activity worsens fatigue.

Symptoms of Myasthenia Gravis

1. Ocular Symptoms (Most Common Initial Presentation)

drooping eyelids (ptosis)

Double vision (diplopia)

2. Facial & Bulbar Symptoms

Weak facial expressions

Difficulty chewing or swallowing a food [dysphagia]

Slurred speech dysarthria

3. Limb & Neck Weakness

Weakness of arms and legs

Difficulty holding head up

4. Respiratory Muscle Weakness

Severe cases may cause breathing difficulty (myasthenic crisis) – medical emergency

5. Fatigue Pattern

Weakness is worse with activity, improves with rest

Symptoms fluctuate daily

Complications

Myasthenic crisis: Severe respiratory muscle weakness requiring hospitalisation

Aspiration pneumonia due to swallowing difficulties

If the conditions are left untreated, the result will be physical disability.

Diagnosis

1. Clinical Examination

Observation of muscle weakness and fatigability

Ice pack test for ptosis improvement

2. Blood Tests

Antibodies to detect: anti-AChR, anti-MuSK, anti-LRP4

3. Electromyography (EMG)

Records the electrical activity of muscles and nerve signals

4. Imaging

Chest CT or MRI for thymoma detection

5. Edrophonium (Tensilon) Test (less frequently used nowadays)

Temporary improvement in muscle strength confirms MG

Traditional Medical Treatment

1. Acetylcholinesterase Inhibitors

Pyridostigmine (Mestinon)

Improves communication between nerves and muscles

Temporary reduction of weakness

2. Immunosuppressive Therapy

Corticosteroids (Prednisone)

Immunosuppressants: Azathioprine, Mycophenolate, Cyclosporine

3. Thymectomy

Surgical thymectomy, in particular when thymoma is suspected

Can improve symptoms and may induce remission

4. Plasmapheresis & Intravenous Immunoglobulin (IVIG)

Short-term treatment of myasthenic crisis or severe symptoms

5. Symptomatic & Supportive Care

Speech therapy for dysarthria

Occupational therapy to maintain mobility and independence

Respiratory support in severe cases

Lifestyle and Supportive Measures

1. Activity Management

Rest often to avoid fatigue.

Plan activities during times of day when strength is best

2. Nutrition

Soft foods are easy to swallow.

Small, frequent meals to avoid fatigue

3. Stress Management

Yoga, meditation, and shallow breathing may help lessen flare-ups.

4. Avoid Triggers

Certain medications, such as selected antibiotics and beta-blockers, may exacerbate MG. Extreme heat may lead to weakness. Prognosis: MG is chronic but manageable. Most patients can attain near-normal strength with medications and lifestyle management. Early detection, treatment, and follow-up prevent serious complications like myasthenic crisis. Monitoring is often necessary throughout life.