Myasthenia gravis is a weakening of the body's muscles due to disorders of the nerves and muscles. At first, people with myasthenia gravis will feel tired quickly after doing physical activity, but complaints will improve after resting.
Nerve and muscle disorders are caused by autoimmune, which is a condition when the body's immune system (antibodies) attacks the person's own body. Myasthenia gravis can be experienced by anyone, but this condition is more common in women aged 20-30 years and men aged over 50 years.
If you don't get treatment, muscle weakness in people with myasthenia gravis will get worse over time and make it difficult for the sufferer to move, talk, swallow, and even breathe.
Causes of Myasthenia Gravis
Myasthenia gravis occurs when the immune system is compromised and produces antibodies that attack healthy tissues in the body. In this case, the antibodies attack the tissue that connects nerve cells and muscles, causing the muscles to weaken and the sufferer to tire quickly.
It is not known for certain the cause of autoimmune disorders in patients with myasthenia gravis, but abnormalities in the thymus gland are thought to be a factor that can increase the risk of developing this autoimmune disease.
The thymus gland is a gland in the chest that acts as a producer of antibodies. Some people with myasthenia gravis experience enlargement of the thymus gland due to a tumor or swelling of the gland.
Symptoms of Myasthenia Gravis
The main symptom of myasthenia gravis is muscle weakness. These symptoms will appear after activity and disappear after rest. Over time, the muscles that are used frequently will become weaker and will not improve even after the patient has rested.
Symptoms of myasthenia gravis begin with visual disturbances, such as blurred or double vision, due to weakening of the eye muscles. One or both eyelids may also drop (ptosis).
In addition, myasthenia gravis can affect the muscles of the face and throat. In this condition, the symptoms that appear are:
- Talk becomes slurred.
- Difficulty showing facial expressions, such as smiling.
- Hoarseness.
- Difficulty chewing and swallowing food or drink, making it easy to choke.
- Shortness of breath, especially when lying down or after exercising.
The condition of muscle weakness due to myasthenia gravis can also affect other body parts, such as the muscles of the neck, arms, and legs. Symptoms that can appear are:
- Muscle pain after activity.
- Difficulty lifting head after lying down
- Difficulty moving, such as getting up from a sitting to standing position, lifting objects, going up and down stairs, brushing teeth, or washing hair.
- Disturbance in walking.
Each patient with myasthenia gravis experiences different symptoms. These symptoms develop slowly and tend to get worse within a few years of the appearance of symptoms, if left untreated.
When to go to the doctor
Immediately consult a doctor if one of the muscles in the body feels tired easily, but gets better soon after resting. These symptoms can be an early sign of myasthenia gravis.
Myasthenia gravis is a chronic disease and tends to get worse over time. Patients with myasthenia gravis need to have regular medical check-ups so that the progress of the disease and their condition can be monitored properly.
Patients with myasthenia gravis are advised to go to the emergency room immediately if they experience shortness of breath. This condition can progress to respiratory arrest, so the patient needs to get a breathing apparatus as soon as possible.
Diagnosis of Myasthenia Gravis
In diagnosing myasthenia gravis, the doctor will ask the symptoms that appear and the patient's medical history. Nerve examination is also done to test body reflexes, check muscle strength and mass, test the body's response to touch, and check balance and body coordination.
The doctor will perform follow-up examinations to confirm the diagnosis, and distinguish it from other conditions that also cause muscle weakness, such as: multiple sclerosis. Follow-up tests carried out are:
- Blood tests, to detect the presence of antibodies in the blood that cause muscles to weaken.
- Pulmonary function tests, to check the condition of the lungs and detect respiratory problems due to weakening of the body's muscles.
- Electromyogram (EMG), to measure the electrical activity that flows from nerves to muscles.
- Repetitive nerve stimulation test, to measure the ability of nerves to send signals to muscles.
- Imaging tests, such as MRI and CT scans, to detect the presence of tumors and abnormalities in the thymus gland.
Myasthenia Gravis Treatment
Although there is no effective way to cure myasthenia gravis, the treatment provided by doctors can relieve symptoms, improve muscle function, and prevent paralysis of the respiratory muscles which can be fatal.
The type of treatment is also different for each patient, depending on the age, severity, and overall condition of the patient. Some of the treatment measures to treat myasthenia gravis are:
Drug
Types of drugs used to treat the symptoms of myasthenia gravis include:
- Cholinesterase inhibitors, to increase muscle strength and movement. This drug is used as an initial treatment for myasthenia gravis. An example of this drug is pyridostigmine and neostigmine.
- Corticosteroids, such as prednisone, to inhibit the immune system in producing antibodies.
- Immunosuppressive drugs, such as azathioprine, ciclosporin, methotrexate, and tacrolimus. This drug is also used to suppress the immune system, so that antibody production can be controlled.
- Immunoglobulin (IVIG), which is a normal antibody given through an IV to restore the immune system.
- Monoclonal antibodies, for example rituximab, which is a drug given through an IV to relieve the symptoms of myasthenia gravis that cannot be treated with other types of treatment.
Plasmapheresis
Plasmapheresis is a procedure to remove blood plasma with a special machine. Plasma will be removed and replaced with a special fluid to remove antibodies that cause myasthenia gravis. These antibodies are in the blood plasma.
Operation
If the patient with myasthenia gravis also has an enlarged thymus gland, the doctor will perform surgery to remove the gland. This surgical procedure is called a thymectomy.
To relieve the symptoms of myasthenia gravis, a thymectomy procedure is sometimes still performed even though the patient does not have an enlarged thymus gland. However, this surgical procedure is only recommended for people with myasthenia gravis over the age of 60.
Complications of Myasthenia Gravis
The most dangerous complications of myasthenia gravis are: myasthenic crisis. This condition occurs when the throat and diaphragm muscles are too weak to support the breathing process, so the sufferer experiences shortness of breath due to paralysis of the respiratory muscles.
Myasthenic crisis It can be triggered by several factors, such as a respiratory infection, stress, or complications from a surgical procedure. On myasthenic crisis In severe cases, the patient may stop breathing. In this condition, a breathing apparatus (ventilator) is needed to help the sufferer breathe, until the respiratory muscles can move again.
In addition to stopping breathing, people with myasthenia gravis are also at high risk of developing other autoimmune diseases, such as thyrotoxicosis, lupus, and diabetes. rheumatoid arthritis.
Prevention of Myasthenia Gravis
There is no way that can be done to prevent mysthenia gravis. Even so, there are several ways to prevent myasthenia gravis symptoms from getting worse, namely:
- Prevent infection, by washing hands before eating and after defecating, and using a mask when close to people who are sick.
- Do not do strenuous or excessive activity.
- Maintain body temperature so that it is not too cold or too hot.
- Control stress, for example by doing meditation or yoga.