Myasthenia gravis (MG) is an autoimmune disease, which affects the communication between nerves and muscles. People with MG lose the ability to control muscles voluntarily. They experience muscle weakness and fatigue of various severity. They may not be able to move muscles in the eyes, face, neck, and limbs.
MG is a lifelong neuromuscular disease. MG mostly affects women aged 20 to 40 and men aged 50 to 80. About one in 10 cases of MG occur in teenagers(Juvenile MG). The illness can affect people of all ages but is rare in children.
Autoimmune myasthenia gravis is the most common form of this neuromuscular disease. It may have the following types –
In this type of MG muscles that move the eyes and eyelids become weak. The eyelids may droop, or you may not be able to keep your eyes open. Some people have double vision. Eye weakness is usually the first sign of MG. Nearly half of people with ocular MG evolve into the generalized form within two years of the first symptom.
Muscle weakness affects the eye and other body parts such as the eye and other body parts such as the face, neck, arms, legs, and throat. You may find it difficult to speak or swallow, lift your arms over your head, stand up from a seated position, walk long distances and climb stairs.
Muscle weakness caused by MG worsens as the affected muscle is used. Because symptoms usually improve with rest, muscle weakness can come and go. However, the symptoms tend to progress over time, usually reaching their worst within a few years after the onset of the disease.
Although MG can affect any of the muscles that you control voluntarily, certain muscle groups are more commonly affected their others.
• Eye muscles
In more than half of people who develop MG, their first sign and symptoms involve eye problems, such as –
* Drooping of one or both eyelids (ptosis)
* Double vision (diplopia), which may be horizontal or vertical, and improves or resolves when one eye is closed.
• Face and throat muscles
In about 15% of people with myasthenia gravis, the first symptoms involve face and throat muscles, which could be –
* Impair speaking where speech might sound soft or nasal
* Difficult in swallowing food, drink, or taking pills.
* Hard in the chewing process
* Change facial expressions like your smile might look like a snarl
• Neck and limbs muscles
* Weak neck muscles make it hard to hold up your head
* Weakness in your legs can affect how you walk
Myasthenia gravis is a neuromuscular disorder that’s usually caused by an autoimmune problem.
Your nerves communicate with your muscles by releasing chemicals that fit precisely into receptor sites on the muscle cells at the nerve-muscle junction.
In myasthenia gravis, your immune system produces antibodies that block or destroy many of your muscle’s receptor sites for a neurotransmitter called acetylcholine. With fewer receptor sites available, your muscles receive fewer nerve signals, resulting in weakness.
Antibodies can also block the function of a protein called muscle-specific receptor tyrosine kinase, sometimes referred to as MuSK. This protein is involved in informing the nerve-muscle junction. Antibodies against this protein can lead to myasthenia gravis.
• Thymus gland
The thymus gland is a part of your immune system situated in the upper chest beneath your breastbone. This gland triggers or maintains the production of the antibodies that block acetylcholine.
Rarely, mothers with myasthenia gravis have children who are born with myasthenia gravis. If treated promptly children generally recover within two months after birth.
Risk Factors –
• History of other autoimmune diseases, such as rheumatoid arthritis and lupus.
• Medications for malaria, heart, arrhythmias, and cancer.
• Surgical procedures
• Thyroid disease
One of the most dangerous potential complications of MG is a myasthenic crisis. This consists of life-threatening muscle weakness that can include breathing problems.
Individuals with MG are at a higher risk of developing other autoimmune disorders such as lupus and rheumatoid arthritis.
Along with physical examination following test could be done to confirm the diagnosis –
• Icepack test
• Antibody test
• Imaging scans such as MRI or CT scans
• Electromyogram (EMG)
There is no cure for MG. The goal of treatment is to manage symptoms and control the activity of your immune system.
Corticosteroids and immunosuppressants can be used to suppress the immune system. These medications can help minimize the abnormal immune response that occurs in MG.
• Thymus gland removal
As the thymus gland is removed, patients typically show less muscle weakness.
• Plasma exchange (Plasmapheresis)
This process removes harmful antibodies from the blood, Which may result in an improvement in muscle strength.
• Intravenous immune globulin (IVIG)
IVIG is a blood product that comes from donors. It’s used to treat autoimmune MG. It is said that it affects the creation and function of antibodies.
Ayurvedic Perspective –
Ayurveda explains Myasthenia Gravis as the vitration of Vata and Kapha dosha at the site of muscles. It is a condition resulting in weakness and reduced activity which indicates that the function of Vata obstructed. Thus it is an Aavaranja Vata Vyadhi and the aavarana is more with Kapha dosha. Therapies that must be done along with safeguarding the digestive fire and maintaining immunity.
Ayurveda suggests following Panchakarma therapies for MG-
• Kizhi Swedan
• Shalishashtik Swedan
Since in most cases eye muscles are affected, specific treatment procedures to the eyes are done here. They includes –
These therapies help improve nerve-muscle coordination by removing toxins from the body.
Along with the above therapies proper after care with suitable diet and practice of yoga such as breathing exercises in pranayam is required
Rasayan or rejuvenation therapy should be sought to after general course of treatment to revitalize the body tissues.
• Swarna Bhasm
• Abhrak Bhasm
• Pravala Pisti
• Kamdugdha Ras
• Giloya Satwa
• Shiroshuladi Vajra Ras
• Ashwagandha Churna
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