Myasthenia Gravis

Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder. It is characterized by fluctuating weakness of voluntary muscle groups. Muscle groups most commonly affected include the eye muscles, facial, chewing and swallowing muscles, and shoulder and hip muscles. Muscles that assist breathing may be affected also.

MG occurs in all races, both genders and at any age. MG is not directly inherited or is it contagious. It does occasionally occur in more than one member of the same family. The prevalence of MG in the United States is estimated to be about 20/100,000 population. However, MG is probably under diagnosed and the prevalence may be higher.

MG signs and symptions may include drooping eyelids, double vision, slurred speech, nasal quality to speech, inability to speak, drooling, nasal regurgitation, weak cough, problems chewing and/or swallowing, choking, trouble sitting up or holding head erect, trouble walking, feeling short of breath.

Medical emergencies ("crises") are rare, but may occur when the muscles that support respirations are so weak that breathing becomes very difficult. Respirations may be shallow and ineffective. The airway may become obstructed due to weakened throat muscles and accumulated secretions.

Diagnosis. There are many disorders that cause weakness. In addition to a complete medical and neurological evaluation, a number of tests may be used to establish a diagnosis of MG. A blood test for the abnormal antibodies can be performed to see if they are present. Electromyography (EMG) studies can provide support for the diagnosis of MG when characteristic patterns ae present. The edrophonium chloride (Tensilon) test is performed by injecting this chemical into a vein. Improvement of strength immediately after the injection provides strong support for the diagnosis of MG. Sometimes all of these tests are negative or equivocal in someone whose story and examination still seem to point to a diagnosis of MG. The positive clinical findings should probably take precedence over negative confirmatory tests.

Treatment. There is no known cure for MG, but there are effective treatments that allow many, but not all, people with MG to lead full lives. Common treatments include medications, thymectomy and plasmapheresis. Spontaneous improvement and even remission may occur without specific therapy.

Prognosis. The current treatments for MG are sufficiently effective that the outlook for most patients is bright. Althought the treatments will not cure MG, most patients will have significant improvement in their muscle weakness. In some cases, MG may go into remission for a time, during which not treatment is necessary. There is much that can still be done and still much to understand. New drugs to improve treatments are needed. Research plays an important role in finding new answers and treatments for MG.

Myasthenia Gravis Information courtesy of the Myasthenia Gravis Foundation of America, Inc.

mgfa@myasthenia.org, www.myasthenia.org

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