From the Guidelines
Myasthenia gravis is a chronic autoimmune disorder characterized by muscle weakness that worsens with activity and improves with rest, with common symptoms including drooping eyelids, double vision, difficulty swallowing, and breathing difficulties, as reported in the most recent study 1. The symptoms of myasthenia gravis can be highly variable, with some patients experiencing mild symptoms and others experiencing more severe symptoms that can impact their quality of life.
- Common symptoms include:
- Drooping eyelids (ptosis)
- Double vision (diplopia)
- Difficulty swallowing (dysphagia)
- Slurred speech (dysarthria)
- Weakness in the arms and legs
- Breathing difficulties in severe cases The diagnosis of myasthenia gravis is typically made based on a combination of clinical evaluation, laboratory tests, and imaging studies, as outlined in the study 1.
- The presence of anti-acetylcholine receptor antibody (AChR-Ab-binding, blocking, or modulating) can confirm the diagnosis, although some patients may be seronegative.
- Repetitive nerve stimulation testing and single fiber electromyography may also be used to assist in diagnosis. The management of myasthenia gravis typically involves a combination of medical and surgical treatments, with the goal of reducing symptoms and improving quality of life, as discussed in the study 1.
- Pyridostigmine bromide is often used as a first-line treatment, although some patients may not respond well to this medication.
- Corticosteroids and immunosuppressive therapy may also be used to manage symptoms.
- Thymectomy may be indicated in some cases, particularly in patients with thymoma.
- Surgical intervention for strabismus may be considered in some cases, although this is typically reserved for patients who have achieved remission or stabilization of the disease.
From the Research
Myasthenia Gravis Symptoms
- Myasthenia gravis (MG) is a rare autoimmune disease characterized by exertion-induced muscle weakness that can lead to potentially life-threatening myasthenic crises 2.
- The disease is caused by detectable antibodies directed against specific postsynaptic structures of the neuromuscular junction 2.
- MG is a chronic condition that can be improved through therapies, but to date, not cured 2.
Treatment Options
- Standard treatment for MG includes symptomatic treatment with acetylcholine-esterase inhibitors and disease-modifying treatment with steroids, steroid-sparing immunosuppressants, and thymectomy 2, 3.
- However, a significant proportion of patients do not achieve satisfactory clinical improvement under standard treatment, and long-term therapy with steroids can cause significant side effects 2.
- New biological therapies, such as complement inhibitors and FcRn inhibitors, have been approved as add-on treatment options, providing new optimism for patients reaching minimal manifestation status 2, 4.
Symptomatic Treatment
- Pyridostigmine is the most commonly used drug in the symptomatic treatment of MG, with a reported median effectiveness of 60% and net benefit of 65% 5.
- However, side effects are common, with 91% of patients currently using pyridostigmine reporting side effects, including flatulence, urinary urgency, muscle cramps, blurred vision, and hyperhidrosis 5.
- Acetylcholinesterase inhibitors, such as pyridostigmine, can be used as a substitute for intravenous immunoglobulin or plasmapheresis in myasthenic crisis, but caution should be observed due to possible complications 6.
Disease Management
- The diagnosis of MG can generally be made from the patient's history, a neurologic examination, and laboratory and electrodiagnostic testing 4.
- Carefully selected treatment improves outcomes in MG, and additional treatment options are likely to be available in the near future 4.
- Patients with MG can be classified based on antibody status and clinical presentation, and treatment responses may differ based on disease subtypes 4.