Myasthenia gravis is an autoimmune disease in which antibodies block communication between nerves and muscles. The hallmark is weakness that worsens with use and improves with rest.
It is very treatable, and most people lead a normal life on medication. It is a long-term condition, though, and flare-ups affecting breathing or swallowing can be dangerous.
Symptoms
- Drooping eyelids, often worse in the evening
- Double vision
- Slurred or nasal speech
- Difficulty chewing and swallowing
- Weakness of neck, shoulders and hips
- Breathlessness when lying flat or on exertion
- Symptoms that fluctuate through the day
Causes and risk factors
Most patients have antibodies against the acetylcholine receptor; a smaller group has MuSK or LRP4 antibodies, and some have none detectable. The thymus gland is involved: about 10 to 15 in 100 patients have a thymoma and many younger patients have an enlarged thymus. Infections, surgery, pregnancy and certain drugs, including some antibiotics, magnesium and beta blockers, can worsen it.
How it is diagnosed
- Antibody blood tests: Acetylcholine receptor and MuSK antibodies confirm the diagnosis in most people.
- Repetitive nerve stimulation and single-fibre EMG: Show the failure of transmission; single-fibre EMG is the most sensitive test.
- CT or MRI of the chest: Looks for thymoma or thymic enlargement.
- Ice pack test: Eyelid droop that improves after cooling supports the diagnosis at the bedside.
Treatment options
- Pyridostigmine: Improves strength for a few hours per dose; often enough for mild or eye-only disease.
- Steroids and steroid-sparing drugs: Prednisolone with azathioprine or mycophenolate to control the immune attack.
- Thymectomy: Essential for thymoma, and improves outcomes in many antibody-positive adults under about 65. Often done by keyhole or robotic surgery.
- IVIg or plasma exchange: Fast-acting rescue for severe flares and before surgery.
- Newer targeted therapies: Complement inhibitors and FcRn blockers such as efgartigimod for disease that resists standard treatment.
When it is urgent
Increasing difficulty breathing, swallowing or holding up your head is a myasthenic crisis and needs an emergency department with intensive care at once. Never fly with worsening bulbar or breathing symptoms.
Travelling to Türkiye for treatment
A planned thymectomy is a sound reason to travel once your myasthenia is stable, with a stay of around 10 to 14 days. Diagnostic confirmation and treatment review also fit a visit. Dose adjustments and monitoring of immunosuppressants need a neurologist at home.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Does thymectomy cure myasthenia?
It raises the chance of remission and lowers medication needs over 1 to 3 years, but it is not a certain cure.
Which medicines should I avoid?
Carry a list. Aminoglycoside and fluoroquinolone antibiotics, magnesium infusions and several others can worsen weakness.
Can I have cosmetic botulinum toxin?
It is generally advised against, because it acts on the same junction and can trigger weakness.
Is pregnancy possible?
Yes, with planning. Some drugs such as mycophenolate must be changed beforehand.