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Myasthenia Gravis Print E-mail
by Ron Kennedy, M.D., Santa Rosa, CA

Dr. Kennedy Myasthenia gravis (which means literally serious muscle weakness) is a chronic autoimmune disease which affects the skeletal muscles (the muscles under voluntary control). This disorder does not affect such muscles as the intestinal tract or heart which are not under voluntary control. Autoimmune disorders are caused when the body's immune system, which is meant to defend the body against bacteria, viruses, and any other foreign product, malfunctions and produces antibodies against healthy tissue, cells and organs.

Myasthenia gravis is characterized by rapid muscular fatigue which will reverse with rest. This is caused by a deficiency of the transmitter substance (called acetylcholine) which carries the signal from the end of a motor nerve to the surface of muscle cells. Acetylcholine causes contraction of muscles. Other possible symptoms are as follows: weakness of eye muscle resulting a droopy eyelid (ptosis), weakness of smiling muscles, weakness of swallowing, weakness of chewing, weakness of talking, blurred vision, unstable or waddling gait, weakness in arms, hands and fingers, difficulty swallowing, and difficulty breathing.

There are several forms of myasthenia gravis. One form, restricted ocular MG (ROMG), usually affects only the muscles controlling eye position, resulting in weakness and a droopy or sleepy appearance. ROMG often develops into generalized myasthenia (GMG). It is probable that ROMG is an autoimmune disease in which an autoantibody is directed at extraocular muscles. In persons with ROGM, it is usually difficult to detect the auto-antibodies that are the hallmark of generalized myasthenia gravis.

GMG is a chronic autoimmune neuromuscular disease which can affect all of the skeletal muscles, including the extraocular muscles. It may occur alone or in combination with other autoimmune disorders.

There is also a drug-induced form of MG caused by the prescription drug D-Penicillamine. Drug-induced MG usually disappears when the drug is stopped.

The usual patient with early onset of generalized myasthenia gravis is female, with the disease beginning before the age of 40 and has an association with hyperplastic (overgrown) thymus gland. (The thymus gland is located just above and behind the breast bone and regulates the immune system.) Late onset generalized myasthenia gravis affects both male and females equally and occurs after the age of 40 years. It is associated with the presence of a thymoma, a tumor of the thymus gland.

Treatment may include medications, thymectomy (surgical removal of the thymus gland) and plasmapheresis. The role of the thymus gland in MG is not fully understood, and the thymectomy may or may not improve symptoms. Plasmapheresis is a procedure that removes abnormal antibodies from the blood and replaces the child's blood with normal antibodies through donated blood. Medications. Drugs used include cholinesterase inhibitors such as neostigmine and pyridostigmine. These drugs help improve nerve signals to muscles and increase muscle strength. Immunosuppressive drugs such as prednisone, cyclosporine, and azathioprine may also be used to suppress the production of abnormal antibodies. They must be used with careful medical followup because they can be associated with major side effects.



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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