Myasthenia Gravis Clinical Manifestations

Written by Tang Bo
Neurology
Updated on September 01, 2024
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The clinical manifestations of myasthenia gravis include fluctuating weakness of specific striated muscles that is fatigue-prone. Symptoms are generally milder in the morning and worsen by night, increasing after sustained activity and alleviating after rest. Additionally, some patients may experience ocular muscle weakness, presenting with ptosis and diplopia, which could be among the earliest symptoms. Eye movement disorders may occur, preventing the eyes from looking to one side, and pupil abnormalities may be present. Facial muscle weakness can lead to cheek puffing and air leakage, inability to close the eyes, or asymmetry of the mouth, resembling a forced smile. There may also be weakness in the masticatory muscles, leading to difficulties in chewing and swallowing, potential speech impairments, and coughing when drinking water. Neck muscle weakness may manifest as difficulty in lifting the head. Muscle weakness can affect various limbs, primarily proximally, and respiratory muscle weakness can lead to breathing difficulties and dryness.

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Written by Zhang Hui
Neurology
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What is myasthenia gravis?

Myasthenia gravis is a group of neuromuscular junction disorders and is also an autoimmune disease of the nervous system. It primarily involves the production of certain antibodies in the body that attack the acetylcholine receptors on the postsynaptic membrane of the neuromuscular junction. This results in the inability of nerve impulses to be effectively transmitted to the muscles, causing the muscles to lose neural control, leading to weakness of the limbs. This weakness is typically more pronounced in the evening than in the morning, with symptoms being lighter upon waking and worsening in the afternoon. As the disease is caused by an autoimmune response, a major focus of treatment is to suppress this abnormal immune reaction, primarily through the administration of corticosteroids. Additionally, many patients with myasthenia gravis also exhibit thymus abnormalities, necessitating thorough CT examinations of the thymus.

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Written by Zhang Hui
Neurology
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Can myasthenia gravis be cured completely?

Myasthenia gravis is a relatively common disease in neurology. Whether it can be completely cured mainly depends on the severity of the disease and some of its subtypes. For instance, patients with ocular myasthenia gravis only exhibit symptoms such as ptosis; by using some corticosteroids or acetylcholinesterase inhibitors, some patients can be cured. However, there are also patients who experience generalized muscle weakness, which is particularly severe and may even affect the respiratory muscles. These patients need long-term or even lifelong medication to prevent the recurrence of severe myasthenia gravis. Additionally, some patients with myasthenia gravis also have thymomas, and many patients can be cured after the removal of the thymoma. Therefore, most cases of myasthenia gravis cannot be completely cured and require long-term medication, though a small portion might be curable.

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Written by Tang Bo
Neurology
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Types of myasthenia gravis crisis

Myasthenic crises are categorized into three types, all resulting from worsening conditions or improper treatment, leading to respiratory muscle weakness or paralysis and subsequent difficulty in breathing. The first type occurs due to various triggers or reduction in medication, or after the application of acetylcholinesterase inhibitors which temporarily alleviate the crisis, known as the cholinergic crisis. The second type is a result of excessive use of acetylcholinesterase inhibitors during a cholinergic crisis. Beyond respiratory difficulties, symptoms may also include signs of toxicity such as vomiting, abdominal pain, diarrhea, pupil constriction, excessive sweating, drooling, increased tracheal secretions, and potential muscle tremors, spasms, as well as anxiety, insomnia, confusion, seizures, and coma. The third type is the paradoxical crisis, where neither ceasing nor increasing medication doses alleviates the symptoms, typically occurring after long-term, high-dose medication use.

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Written by Zhang Hui
Neurology
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How to alleviate myasthenia gravis?

Myasthenia gravis is a disease of the department of neurology and its incidence is not low, it is also relatively common clinically. The treatment of myasthenia gravis mainly includes the following points: First, if patients with myasthenia gravis also have a thymoma, it is recommended to surgically remove the thymoma as soon as possible, which can significantly alleviate the symptoms of myasthenia gravis and reduce the amount of medication needed. Second, provide patients with some medication, mainly some drugs that suppress the immune response, including some corticosteroids. The use of corticosteroids is relatively complex, and must be gradually increased or decreased under the advice of a doctor. Do not stop taking them on your own. There are also some drugs that are cholinesterase inhibitors, which can increase the content of acetylcholine in the synaptic gap, alleviating the patient's symptoms. In addition, research has confirmed that some new immunosuppressive agents can also be used in the treatment of myasthenia gravis. In summary, the treatment of myasthenia gravis is a comprehensive subject and must be tailored according to the patient's condition.

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Written by Zhang Hui
Neurology
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Myasthenia gravis often co-occurs with which diseases?

Myasthenia gravis is a type of autoimmune disease of the nervous system, mainly caused by the production of abnormal antibodies in the body. These antibodies affect the acetylcholine receptors in the postsynaptic membrane, thereby impacting the transmission of nerve impulses at the neuromuscular junction. Being an autoimmune disease, myasthenia gravis usually coincides with the following conditions: The first major category is thymus diseases, with most patients experiencing thymic hyperplasia, and particularly, there may be cases of thymoma. If there is a thymoma, it is advised to undergo surgical treatment promptly. The second major category may involve hyperthyroidism, so it is essential to test thyroid function. Thirdly, some patients may also test positive for antinuclear antibodies, which requires careful differential diagnosis.