From the Guidelines
Yes, patients with myasthenia gravis can experience weakness in the torso muscles, which can affect their quality of life and increase morbidity and mortality risk if not properly managed. Myasthenia gravis is an autoimmune neuromuscular disorder that causes muscle weakness and fatigue, which can affect any voluntary muscle in the body, including those in the torso 1. The condition occurs when antibodies block or destroy acetylcholine receptors at the neuromuscular junction, preventing proper nerve signal transmission to muscles. Torso involvement may manifest as weakness in the abdominal or back muscles, potentially causing difficulties with posture, balance, and core stability. In severe cases, respiratory muscles in the chest and diaphragm can be affected, leading to breathing difficulties that may require urgent medical attention.
Treatment Options
- Acetylcholinesterase inhibitors like pyridostigmine (Mestinon) at doses of 30-60mg every 3-4 hours while awake
- Immunossuppressants such as prednisone (starting at 15-20mg daily and potentially increasing), azathioprine, or mycophenolate mofetil
- In some cases, thymectomy surgery, which is indicated in some cases, always in the presence of thymoma, and may substantially reduce symptoms for certain subpopulations with myasthenia gravis 1.
Monitoring and Management
Patients experiencing torso weakness should be monitored closely, particularly for signs of respiratory compromise such as shortness of breath, as this may indicate a myasthenic crisis requiring immediate medical intervention. The use of anesthetic agents should be done with caution, given any evidence of associated weakness of the respiratory muscles 1. Surgical management, with and without the use of adjustable sutures, has met with modest success in cases where there is a stabilized primary deviation, sometimes exacerbated by fatigue. More than one strabismus surgery may prove necessary.
Key Considerations
- Remission or stabilization of the disease is often possible after 2 to 3 years of treatment 1
- At that point, surgical intervention for strabismus may be considered if desired or if prism use is insufficient
- Efgartigimod alfa-fcab has recently been FDA approved for patients who test positive for the anti-acetylcholine receptor and may be offered by treating neurologists as an alternative treatment option 1.
From the Research
Myasthenia Gravis and Torso Involvement
- Myasthenia gravis (MG) is a chronic autoimmune disorder of the neuromuscular junction, characterized clinically by muscle weakness and abnormal fatigability on exertion 2.
- The disease can affect various parts of the body, including the torso, as it involves the neuromuscular junction transmission 3.
- Involvement of respiratory musculature, which is part of the torso, can lead to life-threatening crisis requiring intensive care unit care 3.
- Treatment of MG includes short-term symptomatic treatment, chronic immunosuppression, surgical intervention, and immunomodulatory therapies for severe disease or crisis, which may help manage torso involvement 3.
Symptoms and Treatment
- Symptoms of MG can include muscle weakness that worsens with activity and fluctuates over the course of the day, which may affect the torso 3.
- Treatment options for MG consist of symptomatic treatment, immunosuppressive treatment, or thymectomy, which may help alleviate symptoms in the torso 4.
- Pyridostigmine is a commonly used treatment for MG, which can help manage symptoms, including those affecting the torso 2, 5.
Disease Management
- Management of MG should aim at prompt symptom control and the induction of remission or minimal manifestations, which may include managing torso involvement 5.
- Treatment needs to be individualized depending on disease severity, antibody status, comorbidities, and other factors, including torso involvement 5, 6.
- Novel therapies are being developed and trialed, which may provide new treatment options for managing MG, including torso involvement 5, 4.