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• About Myasthenia Gravis
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• About Peripheral Neurothrapy
• About Spondylosis
• About Stroke
• About Oral Anticoagulants

Myasthenia gravis belongs to a group of diseases called autoimmune diseases. Normally, your body's immune system defends you against infections. In autoimmune diseases such as myasthenia gravis, your immune system becomes overactive and out of control. It begins to fight against you, using antibodies. It directs its attack on certain proteins, which are normally present on the surface of muscles, called as receptors. The receptor protein specifically affected in myasthenia gravis is called as the acetylcholine receptor. The function of this receptor is to pick up nerve impulses and transmit them to muscles using a chemical called acetylcholine. In myasthenia gravis, the receptor is damaged by the immune system and nerve impulses get blocked. Hence the muscles cannot work and you feel weak. The reason for the overactive immune system is not known. Sometimes it may be associated with abnormalities of a gland in the chest called as the thymus.

Symptoms include:

• Fluctuating muscle weakness that worsens with activity and improves with rest. Weakness may worsen as the day progresses.
• Fatigue
• Weakness of limbs
• Eye problems such as double vision or drooping eyelids
• Weakness in the muscles of the face, throat, and neck that may cause difficulty in speaking, chewing and swallowing
• Weakness in the respiratory muscles, causing life-threatening breathing trouble

Your doctor can make a diagnosis by listening to your problems and examining you. Tests will confirm the diagnosis. One test, called as the neostigmine or edrophonium test, involves giving you a drug that temporarily restores power to the muscles by supplying the chemical blocked by the disease. A good response to this drug helps confirm the diagnosis. The ENMG test is another test performed. A CT scan will be done to look for any thymus abnormalities. Blood tests may be done to see if antibodies are present.

Yes, myasthenia gravis is treatable. The symptoms of myasthenia gravis can be controlled by medicines that temporarily improve muscle strength by increasing the ability of the muscle to receive impulses from the nerves. Certain medicines can be used for the disease to go into remission. These medicines include steroids and azathioprine, and they act by suppressing your body's immune response. If the thymus is found to be abnormal, it may be removed. In urgent situations, the blood may be cleaned and antibodies removed, a procedure called as plasma exchange. In case of significant breathing trouble, a ventilator may be required till the crisis is overcome.

The degree of weakness can vary from person to person and in the same person, from day to day. You should be aware that stress, any infection of the body, irregular treatment and certain medicines could worsen your disease, leading to worsening weakness and swallowing or breathing problems. Hence any infection, especially respiratory infection, should be treated immediately. Always take your medicines at the correct time. Certain medications that you should avoid are:

• Medicines used for infections: aminoglycosides (e.g. gentamicin), quinolones (e.g. ciprofloxacin), penicillins, macrolides (e.g. erythromycin), quinine, chloroquine
• Medicines used for hypertension and heart disease: beta receptor blocking agents (e.g., propranolol, metaprolol, atenolol), calcium channel blockers (e.g. verapamil)
• Medicines used for seizures: phenytoin, barbiturates, carbamezapine, valproate, gabapentin
• Medicines used for behavioural problems: lithium, amitryptiline, imipramine, haloperidol and other neuroleptic agents
• Medicines used for arrhythmias: procainamide, quinidine, lignocaine
• Medicines used for eye disease: timolol
• High dose corticosteroids
• Magnesium
• Other medicines: vecuronium, D-penicillamine, anticholinergics (e.g. trihexyphenidyl), alpha-interferon, botulinum toxin, iodinated contrast agents

Show this list to your physician whenever a new medicine is prescribed.

Yes, a person with myasthenia gravis may become pregnant and have normal children. Pregnancy should be planned in consultation with your doctor. You will require frequent check ups and interaction with your obstetrician and neurologist throughout the pregnancy. Rarely, babies born to mothers with myasthenia gravis may have transient weakness that disappears soon after birth.

You should immediately see a physician if you have any of the following complaints:

• Worsening of symptoms
• Any new symptoms
• Difficulty in lying down
• Difficulty in chewing or swallowing
• Fever and cough