myasthenia gravis-related antibodies

Written by Tang Bo
Neurology
Updated on January 09, 2025
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Most cases of myasthenia gravis are mediated by acetylcholine receptor antibodies, involving cell-mediated immunity with complement, generally affecting the neuromuscular junction and causing a neuromuscular transmission disorder. This results in an acquired autoimmune disease of muscle weakness. However, a small number of patients with myasthenia gravis are mediated by muscle-specific kinase antibodies or low-density lipoprotein receptor-related protein 4 antibodies. Its main clinical manifestations include skeletal muscle weakness, fatigue, worsening with activity, and significant alleviation or reduction of symptoms after rest and the use of acetylcholinesterase inhibitors. Additionally, the disease can occur at any age, with females being more affected than males before the age of 40. Between 40 and 50 years old, the incidence rates between males and females are comparable, but after 50 years of age, the incidence rate in males is higher than in females.

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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 Tang Li Li
Neurology
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Myasthenia gravis should be seen in the Neurology department.

Patients with myasthenia gravis should consult the department of neurology, as myasthenia gravis is an immune-related neuromuscular junction disorder. Patients often exhibit pathological fatigue, skeletal muscle involvement, and unaffected smooth muscles. The most common type is ocular myasthenia, followed by mild and moderate generalized forms. Adult patients often have thymomas or thymic hyperplasia. Upon diagnosis of myasthenia gravis, it is essential to perform a comprehensive thymic CT scan. If thymic abnormalities are present, referral to thoracic surgery for treatment is needed. If there is no thymic disease, high-dose steroid pulse therapy may be considered. Additionally, it is crucial to determine whether the patient has other coexisting immune abnormalities, such as hyperthyroidism or connective tissue disease, and tailor the treatment accordingly.

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Written by Zhang Hui
Neurology
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What is good to eat for myasthenia gravis?

Myasthenia gravis is an autoimmune disease of the nervous system that primarily affects the neuromuscular junction, leading to muscle weakness and post-exertional fatigue. Some patients may also experience clinical symptoms such as ptosis and diplopia. The main treatments include corticosteroids and immunosuppressants. Patients with myasthenia gravis should pay attention to their diet: First, consume plenty of fresh vegetables and fruits, which are rich in vitamins that can provide sufficient immunity to prevent certain complications. Second, eat foods high in B vitamins, such as animal liver, lean meat, and whole grains, which are beneficial for patients. Third, patients should also consume high-quality proteins, which provide ample nutrition and increase resistance, including items such as milk, beef, and fish.

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Written by Zhang Hui
Neurology
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Myasthenia Gravis Clinical Manifestations

Myasthenia gravis is a type of immunological disease of the nervous system that belongs to neurology. The common clinical manifestations include the following aspects. First, some patients may experience ptosis, where they cannot open their eyes. It usually starts on one side and may also involve abnormal eye movements, such as difficulty in moving the eyes to the left or right, leading to double vision and other clinical manifestations. Second, some patients may experience dysphagia, such as difficulty swallowing, choking on water, and speech articulation disorders. Third, some patients may experience weakness in their limbs, especially an inability to perform strenuous physical activities, such as climbing stairs, which can be significantly affected. These clinical manifestations usually show a pattern of being less severe in the morning and more severe in the evening.

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Written by Liu Yan Hao
Neurology
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Does myasthenia gravis hurt?

Myasthenia gravis does not cause pain. Initially, patients with myasthenia gravis may feel discomfort such as soreness or swelling in the eyes or limbs, blurred vision, or fatigue. As the condition progresses, skeletal muscles become noticeably fatigued and weak. A significant characteristic is muscle weakness, which worsens after exertion in the afternoon or evening and improves after rest in the morning, known as "morning better, evening worse." Patients with myasthenia gravis can experience involvement of skeletal muscles throughout the body, manifesting as drooping eyelids, blurred vision, double vision, strabismus, restricted eye movements, bland facial expressions, a "forced smile" appearance, speech impairments resembling a thick tongue often accompanied by a nasal sound. Additionally, they may have chewing difficulties, coughing or choking when drinking, swallowing difficulties, trouble raising the head, weak shoulder shrugging, difficulty lifting arms, combing hair, climbing stairs, squatting, and getting into vehicles, primarily due to muscle weakness, which does not lead to pain.