Myasthenia Gravis Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Myasthenia gravis is a type of autoimmune disease that attacks the junction between nerves and muscles and causes symptoms of muscle weakness. This disease is quite rare.
Studies note that 7–20 people out of 100,000 adults experience it. This disease is known to be more experienced by women aged around 30 years or men aged around 40-50 years. In the past, the death rate from myasthenia gravis reached 50–80 percent. But now with advances in treatment, the death rate has been reduced to 2 percent.
Symptom
The main symptom of myasthenia gravis is muscle weakness. The muscles that most often experience weakness are the muscles around the eyes, as well as the muscles of the arms and upper legs. Due to eye muscle weakness, the typical symptoms experienced by sufferers of myasthenia gravis are drooping eyelids (usually one side) and experiencing double vision.
In addition, the arms and legs of sufferers generally feel heavy and difficult to move. These complaints usually occur when the sufferer experiences fatigue. And after getting enough rest, the complaints will improve.
In addition, more severe symptoms can also occur. It can be in the form of difficulty swallowing, unclear or slurred speech, difficulty chewing food, and difficulty smiling or showing other expressions.
A dangerous complication that can occur in patients with myasthenia gravis is a myasthenic crisis. Most people with myasthenia gravis have experienced this complication in the first two years after starting to get sick. Symptoms can include:
- Heavy breathing / not relieved
- Can’t take a deep breath
- Hard to breathe
- Difficulty speaking
- Difficulty coughing
- Difficulty expelling phlegm or mucus in the throat
- Difficulty chewing and swallowing food
Reason
Under normal conditions, in order for the muscles to move, the body requires cooperation between the nerves and muscles. Between these nerves and muscles, there is a connection called the neuromuscular junction. In order for commands from the nerves to be carried out by the muscles, there needs to be a substance called acetylcholine which is released at the neuromuscular junction which will be captured by the receptors to be passed on to the muscles.
In myasthenia gravis, there are abnormal antibodies that prevent acetylcholine from being captured by receptors. As a result, commands from the nerves cannot be passed on to the muscles. Thus, even though the body wants to move the muscles, the muscles remain limp and do not contract.
Until now, the cause of the appearance of these abnormal antibodies is unknown. However, in 75 percent of cases of myasthenia gravis, a disturbance in the thymus gland is found in the form of an enlarged thymus gland or a tumor on the thymus gland (thymoma).
Diagnosis
The diagnosis of myasthenia gravis is confirmed by a neurologist. In the early stages, the doctor will conduct targeted interviews and physical examinations, as well as examinations to assess muscle strength. Next, the doctor will suggest testing for antibodies to the acetylcholine receptor.
Generally, people with myasthenia gravis have positive antibody test results. In addition, an anti-striated muscle (anti-SM) examination can also show positive results. All of these antibody tests were taken from blood samples.
In addition to blood tests, chest X-rays are generally performed to determine if there is an enlarged thymus gland. If an enlarged thymus gland is found, a CT scan needs to be done. Furthermore, to assess the relationship between nerves and muscles, as well as assess muscle weakness that occurs, an electromyography (EMG) examination performed by a neurologist also needs to be performed.
Treatment
Treatment for myasthenia gravis varies greatly, depending on the type and severity of the symptoms experienced by sufferers. Patients who experience only mild symptoms will generally receive cholinesterase inhibitor class drugs which are consumed every day to prevent their symptoms from getting worse.
However, in severe symptoms up to a myasthenic crisis, in addition to cholinesteration inhibitors, immunosuppressive drugs such as corticosteroids, azathioprine, methotrexate, cyclosporine, and so on will be given. Not infrequently, plasmapheresis and administration of immunoglobulin into the veins (intravenous immunoglobulin / IVIG) also need to be given.
If a tumor is found in the thymus gland (thymoma), surgical removal of the tumor by a thoracic and cardiovascular surgeon is generally also needed to relieve the problem.
In principle, myasthenia gravis is a chronic disease whose symptoms come and go. Therefore, apart from medication, it is very important for people with myasthenia gravis to know the following:
- Early symptoms of a myasthenic crisis include tightness or discomfort when breathing. If these symptoms occur, immediately visit the nearest hospital.
- Women who experience myasthenia gravis should consult their doctor if they want to plan pregnancy and childbirth. This is because children born to sufferers of myasthenia gravis can experience similar disorders.
- There are several types of drugs that can trigger symptoms of myasthenia gravis, such as aminoglycosides, ciprofloxacin, chloroquine, procaine, lithium, phenytoin, beta-blockers, procainamide, and quinidine.
Prevention
Until now, there is nothing that can be done to prevent myasthenia gravis.