Neurotalk myasthenia gravis
Myasthenia Gravis and MS? - NeuroTalk Support Groups
| 01-30-2013, 04:42 PM | #1 |
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Junior Member
Join Date: Aug 2008 Posts: 85 My Mood: |
Myasthenia Gravis and MS? Does anyone have both of these conditions? I have clinically definite RRMS confirmed by MRI, spinal tap (no bands though) and the motherlode of blood work (16 vials if memory serves correct). I've had some other issues like lockjaw that MS doesn't explain. Neuro is now sending me for nerve conduction and EMG testing. He hasn't said the words Myasthenia gravis, but I think it explains a lot for me. Just wonderful. One disease wasn't enough! |
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| 01-30-2013, 05:24 PM | #2 |
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Member
Join Date: Aug 2009 Posts: 642 |
I'm sorry you are going through this. Yes, having both diseases simultaneously can happen. It makes for a more challenging treatment strategy, but sometimes the same drugs can be used to treat both conditions. "Lockjaw" doesn't sound very much like MG to me, unless I am not understanding what you mean. With MG, usually the opposite is the problem--the jaw is weak and can hang open. Locking of the jaw can be something as simple as TMJD, which I have as well. That. of course is more of a structural/joint problem, not a weak muscle issue. In any case, I hope you find some answers soon, so you can begin to pursue treatment. Please feel free to share some of those other symptoms that aren't explained by MS as well. |
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It sounds really tough.| 01-30-2013, 05:42 PM | #3 | |
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Join Date: Jan 2013 Location: Illinois Posts: 107 |
Quote:
Hi! I would be also be interested to hear which of your symptoms are MS related and which ones you don't yet have an explanation for... Hang in there! And good luck to you! |
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| 01-30-2013, 11:27 PM | #4 | |
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Join Date: Jan 2013 Posts: 15 |
Keep an open dialog. Quote:
absolutely correct about the lockjaw. Muscles aren't strong enough to tighten or cramp anymore. |
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..and clear mind
| 01-31-2013, 04:10 AM | #5 |
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Join Date: Dec 2010 Posts: 166 My Mood: |
My record is 24 vials. A few people have been talking about having both diagnoses on the Facebook groups lately. |
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And that wasn't even the time I passed out and they had to call a code blue!| 01-31-2013, 10:54 AM | #6 |
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Hi there, well I have "possible MS" diagnosis now. So, it's possible I have both, yes. I also have a lock jaw (no bananas for me!) but that's not related, I got it because I had an operation on my jaw 10 years ago. |
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Finally.| 02-01-2013, 12:13 AM | #7 |
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MS lesions are the same as the lesions that are commonly seen with Chronic Lyme Disease, FYI. |
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Jaw problems are also extremely common with Chronic Lyme.
Myasthenia Gravis
Myasthenia gravis is an incurable autoimmune disease that affects the muscles and the nerves that control them. It occurs when the parts of the immune system that normally attack bacteria and viruses (antibodies) accidentally attack the connection between the nerve and muscle, also known as the neuromuscular junction. This causes muscle weakness that can become severe enough to interfere with breathing and swallowing saliva or food, resulting in food or saliva going into your airway.
Serious complications like these can result in injury or even death if left untreated.
Myasthenia gravis happens more often in young women (under 40) and older men (over 60), but can impact anyone at any age. For pregnant women with the disease, it is very important to follow your doctor’s recommendations for prenatal care. Babies born to mothers with myasthenia gravis usually do not get the disease but may suffer weakness for a few weeks following birth.
The most-common and milder symptoms of myasthenia gravis are:
- Being overly tired
- Drooping eyes and head
- Double vision or difficulty holding a steady gaze
- Trouble talking or hoarseness
- Facial paralysis
- Difficulty chewing, frequent gagging, drooling, or choking on food
- Trouble climbing stairs, lifting things, or standing up from a seated position
Symptoms may get worse as the day goes on or after:
- Strenuous physical activity (for the large muscles
- Eating (for chewing/swallowing muscles)
- Reading (for the eye muscles)
Mild symptoms may get better with rest.
Severe symptoms include having trouble breathing and not being able to swallow. This becomes more likely when rest fails to resolve mild symptoms.
Call your doctor If you experience:
- Symptoms that do not resolve with rest
- Severe muscle weakness
- Difficulty breathing or swallowing that is worse than normal
If you have trouble breathing or choke badly, you might need to call 911 and go directly to the emergency room.
With myasthenia gravis, antibodies in the immune system block the production of a chemical in the body called acetylcholine, which is released by nerve endings to activate muscles, creating movement. Blocking this chemical causes weakness.
The disease can result from a tumor in the thymus (an important immune system organ located in the neck that produces a key type of white blood cell).
Risk factors for myasthenia gravis include having a personal or family history of autoimmune diseases.
Men over 60 and women under 40 are at higher risk. Additionally, having myasthenia gravis increases the risk of having other autoimmune diseases like rheumatoid arthritis or lupus.
Your doctor will ask you about your symptoms and perform a physical examination to check for muscle weakness, reflexes, and sensation (what you can feel).
You will likely have some blood work and other tests. More blood work might be ordered to look for signs that the immune system might be attacking the muscles.
Your doctor may order a nerve conduction study, called electromyography (or EMG), which is a test that checks the health of the muscles and the nerves that control the muscles.
There is no cure for myasthenia gravis, but people with the disease can experience long-term remission. Treatments include:
- The Myasthenia Gravis Foundation
- National Institute of Neurological Disorders and Stroke
- American Academy of Neurology
- Medline Plus
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Myasthenia gravis - what is it, symptoms, causes, treatment, clinical guidelines
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Article content:
- Causes of
- Symptoms of myasthenia gravis
- Classification
- Myasthenia Diagnosis
- Treatment of myasthenia gravis
- Complications
- Prophylaxis
What is myasthenia gravis?
Myasthenia gravis is an autoimmune disorder that results in muscle weakness due to impaired neuromuscular transmission.
Most often there is a violation of the masticatory, facial, eye muscles, less often - the muscles of the respiratory system.
The main signs of myasthenia gravis are ptosis of the lower eyelid, impaired chewing and swallowing function, nasal voice. Diagnosis is based on a blood test for antibodies to postsynaptic membrane receptors, as well as the results of a proserine test.
How to treat the disease? The patient is shown taking anticholinesterase drugs that help restore neuromuscular transmission. Symptomatic therapy is also carried out.
Causes
What is myasthenia and what are the main causes of this disease? The exact causes of the development of pathology have not been established. It is only known that the disease is autoimmune in nature.
- various pathologies of the neuromuscular system;
- hyperthyroidism;
- hyperplasia;
- benign or malignant neoplasms;
- chronic stress;
- scleroderma;
- frequent SARS;
- encephalitis;
- hereditary predisposition;
- hormonal disorders;
- certain systemic diseases;
- uncontrolled intake of certain drugs;
- alcohol abuse Source:
Prediction of myasthenia gravis.
Kosachev V.D., Polyakova L.A., Nezgovorova V.V. Health is the basis of human potential: problems and ways to solve them, 2010.; - drug addiction.
Symptoms of myasthenia
Gradually the symptoms increase, the person can no longer take care of himself, he needs the constant help of other people due to severe muscle weakness.
Main features of the eye form:
- eyelid drooping;
- development of strabismus;
- double vision.
During a long conversation, speech disorders may increase, which is caused by increased muscle fatigue.
The complexity of timely diagnosis lies in the fact that the above symptoms may disappear for a while, then reappear. In the absence of timely therapy, the patient becomes disabled. It is also possible death. In the past, when the development of medical science did not allow artificial ventilation of the lungs for a long time, the mortality rate was 80%.
Therefore, when the first alarming symptoms appear, you should immediately contact a specialist and undergo an examination.
In addition, the muscles of the pharynx are affected, which leads to problems with swallowing. The patient's voice changes, nasality appears, speech becomes unclear and slow.
Classification
Local forms:
- 1. Ocular . It manifests itself with symptoms such as strabismus, double vision, bilateral drooping of the eyelids. May lead to disability of the patient, but does not pose a danger to life. If left untreated, it can turn into a generalized form within a few months, which sharply worsens the prognosis. Source:
Epidemiological features of myasthenia gravis. Khatkhe Yu.A., Zabolotskikh N.V., Ivanisova A.V., Petropavlovskaya T.A., Gerasimenko T.A. Kuban Scientific Medical Bulletin, 25 (1), 2018. pp. 195-198. - 2. Cranial . It is manifested by sluggish facial expressions, chewing disorders, slurred speech.
- 3. Bulbarnaya . Manifested by illegible speech, nasal voice, constant ingestion of liquid into the nose.
Generalized forms:
- 1. Congenital . The chronic form of the disease, which is extremely rare. Symptoms appear immediately after birth and persist throughout life.
- 2. Neonatal . Occurs in children who were born to a mother with myasthenia gravis. This is a temporary form of the disease. Symptoms disappear on their own after a few weeks or months after birth.
- 3. Juvenile . Most often observed in children over 10 years of age. In young children, it can develop at lightning speed, acutely. If therapy is not started on time, the prognosis is poor.
- 4. Myasthenia gravis in adults Source:
Myasthenia gravis: modern approaches to treatment. Kaimak T.V., Kalieva A.K., Turgambaeva A.T., Bikbaev R.M. Science and Health, 2014..
Diagnosis of myasthenia
First of all, you need to consult a neurologist.
The doctor will interview and examine the patient, examine the neurological status (muscle strength, reflexes, coordination, muscle tone, touch, vision). The main symptom of the disease is muscle weakness, which regresses after rest.
To confirm the diagnosis, the patient can be prescribed:
- proserine test — an injection of "Prozerin" leads to a temporary increase in muscle strength, after which everything returns to its original state;
- blood test - detect the presence of pathological antibodies that destroy the receptors of nerve impulses responsible for movement in the muscles;
- needle myography - a thin electrode is inserted into the muscle, after which the electrical activity of the muscle fiber is measured;
- repeated stimulations of the nerve - reveal that as you get tired, the conduction of impulses worsens;
- MRI, CT - prescribed for differential diagnosis with thymus tumors.
Treatment of myasthenia gravis
Since the disease is autoimmune, the patient is prescribed drugs that suppress the immune system (cytostatics, hormones, immunoglobulins). "Prozerin" and other specific drugs inhibit the destruction of acetylcholine. This allows you to increase its amount in the body and improve the transmission of nerve impulses. Clinical recommendations also include the use of potassium supplements to speed up the arousal process.
If neoplasms in the thymus are found at the time of diagnosis, then surgical removal of this gland is indicated, followed by radiation therapy. Indications for surgical intervention are the generalized form of the disease in patients under 70 years of age and the progression of the pathology, despite ongoing treatment. Source:
Myasthenia gravis: current treatment strategies. Lapshina O., Komshina K., Antipenko E., Gustov A. Vrach, 6, 2017. pp. 12-15.
In addition to specific therapy, the patient is prescribed antioxidants, as well as drugs to relieve side effects from basic medications..gif)
If the level of antibodies in the blood is very high, then it can be purified by artificial methods. After the onset of remission, massage, physiotherapy courses, spa treatment are indicated.
Complications
The main complications of the disease are:
- 1. Myasthenic crisis . This is a life-threatening condition that occurs when the respiratory muscles become too weak and unable to perform their functions. The patient must be immediately transferred to machine breathing. After that, blood purification, drug therapy is carried out, which allows the patient to get out of the crisis and start breathing on his own again.
- 2. Thymus tumors . Diagnosed in approximately 15% of patients with myasthenia gravis. In most cases, the neoplasms are benign.
- 3. Pernicious anemia . With this pathology, vitamin B12 is poorly absorbed from food, which leads to the development of neurological problems.
- 4. Thyroid dysfunction Source:
Treatment and rehabilitation of patients with myasthenia gravis. Bykov Yu.N., Smolin A.I. Siberian Medical Journal (Irkutsk) No. 14, 2013. p.7-9.
Prophylaxis
- proper nutrition;
- refusal of uncontrolled intake of drugs, any treatment should be prescribed by a doctor;
- refrain from alcohol abuse, smoking, drug use;
- compliance with the regime of work and rest;
- giving up a sedentary lifestyle;
- regular outdoor walks;
- exclusion (if possible) of stressful situations;
- avoidance of hypothermia and overheating;
- regular preventive examination by a neurologist.
- Myasthenia prognosis. Kosachev V.D., Polyakova L.A., Nezgovorova V.V. Health is the basis of human potential: problems and ways to solve them, 2010
- Epidemiological features of myasthenia gravis.
Khatkhe Yu.A., Zabolotskikh N.V., Ivanisova A.V., Petropavlovskaya T.A., Gerasimenko T.A. Kuban Scientific Medical Bulletin, 25 (1), 2018. p.195-198 - Myasthenia gravis: modern approaches to treatment. Kaimak T.V., Kalieva A.K., Turgambaeva A.T., Bikbaev R.M. Science and healthcare, 2014
- Treatment and rehabilitation of patients with myasthenia gravis. Bykov Yu.N., Smolin A.I. Siberian Medical Journal (Irkutsk) No. 14, 2013. p.7-9
- Myasthenia gravis: current treatment strategies. Lapshina O., Komshina K., Antipenko E., Gustov A. Vrach, 6, 2017. p.12-15
Article published : 10/28/2016
Last update : 11/06/2022
See also
Neurasthenia
Tourette syndrome
Raynaud's disease
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90,000 the course of the disease. Methods of diagnosis and treatment of myasthenia gravis.Author
Korolev Vyacheslav Vladimirovich
Neurologist of the highest category, doctor of functional diagnostics, vertebroneurologist.
Leading physician
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Neurologist
Creation date: 2020.01.24
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Myasthenia gravis is a neuromuscular disease belonging to the autoimmune group, in which antibodies are formed in the blood against nicotinic acetylcholine receptors of the postsynaptic membrane of the neuromuscular synapse, which leads to impaired neuromuscular transmission.
The prevalence of the disease is low - 10-15 cases per 100,000 population.
Occurs at any age.
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Causes of myasthenia gravis
In most cases (in 60% of patients), hyperplasia (enlargement) of the thymus gland is detected simultaneously with myasthenia gravis (anatomically, this gland is located behind the sternum), and in 10% of patients, thymoma (a tumor of this gland).
Violation of the function of the neuromuscular synapse develops:
-
with myasthenic diseases, for example, with bronchogenic cancer;
-
when taking a number of drugs, including penicillamine, aminoglycosides, streptomycin, polypeptide antibiotics.
Symptoms of myasthenia gravis
The main symptom of the disease is pathological fatigue and weakness of individual or many muscles. Weakness worsens with repeated contractions.
Onset of disease
In many cases, the disease begins with oculomotor disorders in the form of intermittent doubling and drooping of the eyelids (ocular form of myasthenia gravis), which may be absent in the morning, but soon and especially during exercise (reading) increase significantly.
Less commonly, the disease begins with a violation of swallowing (dysphagia), a violation of speech (dysarthria) and a violation of phonation - that is, a change in the sonority of the voice (dysphonia), or with weakness in the limbs (peripheral paresis).
Course of disease
In a small part of patients (about 15%), the manifestations of myasthenia gravis remain local, while in the rest they gradually progress, leading to a generalized form of the disease (i.e., weakness of all muscle groups).
With a generalized course of myasthenia gravis, myasthenic crises can occur, which are manifested by rapidly developing muscle weakness, severe dysphagia, dysphonia, dysarthria and respiratory disorders.
Myasthenic crises are likely when treatment is stopped or develops with the addition of other diseases that can worsen the general condition.
A closely related condition is the cholinergic crisis, which occurs with an overdose of anticholinesterase drugs, but, unlike the myasthenic crisis, the latter is usually accompanied by salivation (hypersalivation), chill-like tremor (i.
e., a feeling of trembling of the whole body), increased sweating, loose stools (diarrhea) , pallor, narrow pupils, low heart rate (bradycardia).
Methods for diagnosing myasthenia gravis
The diagnosis of myasthenia gravis is based on clinical data (the results of a neurological examination) and is confirmed by a drug (proserin) test.
1-3 milliliters of a 0.05% solution of the drug prozerin is injected subcutaneously, after which, after 20-40 minutes, a decrease in muscle weakness becomes noticeable, which is observed within the next 2-3 hours after the drug is administered.
Instrumental diagnostics
Instrumental diagnostic methods are also used.
Conducted electroneuromyography (rhythmic stimulation). In 75% of patients, there is a decrease in the amplitude of muscle potentials when the nerve is stimulated with a frequency of 3 per 1 second.
CT (computed tomography) may reveal thymoma or thymic hyperplasia.
Laboratory diagnostics
Blood tests can detect antibodies to sympathetic cholinergic receptors in 70% of patients with ocular myasthenia gravis and in 80-90% of patients with a generalized form of the disease.
To accurately diagnose the disease, make an appointment with the specialists of the Family Doctor network.
Myasthenia gravis
Anticholinesterase agents are used with individual dose selection. For long-term use, pyridostigmine (kalimin) is used. For a short-term increase in muscle strength before exercise or eating (in cases of swallowing disorders), prozerin is periodically used.
In case of exacerbation or severe course of the disease, treatment with prednisone (hormone therapy) is carried out. If it is ineffective, cytostatic agents (azathioprine or cyclosporine) may be used.
To remove antibodies to acetylcholine receptors, plasmapheresis sessions or intravenous administration of human immunoglobulin are performed.
In the presence of thymoma, as well as patients under the age of 70, removal of the thymus gland is indicated.
Relief of myasthenic and cholinergic crises
To stop the myasthenic crisis, prozerin injections are used in combination with atropine.
