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Zhenzhen Chen

You May Not Just be Overworked; You Might be Sick

“Not just in the limbs, but also in her tongue.” 

— Thomas Willis, describing the first case of myasthenia gravis in 1672


Do you sometimes feel tired, weak, or even struggle to control your body? You might think you just need some rest to recover, but sometimes, it's not just fatigue—it's an illness. If you don't seek medical help in time, you could be at risk of suffocation. This condition is called Myasthenia Gravis, and it can make you lose control over your muscles, including those in your eyes, airways, and other parts of your body.

Figure 1: Muscles Unable to Control Breathing Due to Myasthenia Gravis)

What is Myasthenia Gravis?

Myasthenia gravis (MG) is a chronic disease caused by a disorder of the immune system that disrupts the communication between nerves and muscles, leading to muscle weakness. Thomas Willis first described the symptoms of a myasthenia gravis patient in 1672, and Dr.Friedrich Jolly coined the term "myasthenia gravis" in 1895. Through various cases and experiences, humanity has gradually explored this disease.

Figure 2: Facial muscle weakness

Figure 3: Eye muscle weakness

Epidemiology and Risk Factors

According to the U.S. National Library of Medicine, the annual incidence of myasthenia gravis in the United States is estimated to be about 1 in 500,000, with a prevalence of 1 in 2,500 to 1 in 200,000. In Europe, about 2 in every 10,000 people have MG. The disease usually affects women under 40, young adults aged 20-40, and elderly individuals aged 50-70, regardless of race. Those with a family history of immune system disorders are at higher risk of developing myasthenia gravis.

Figure 4: Damage to the Signal Transmission Process Between Nerves and Muscles

Causes and Symptoms

The exact cause of myasthenia gravis is unclear, but it mainly involves immune system disorders. The patient's body produces antibodies that attack acetylcholine receptors, preventing muscles from contracting properly. Symptoms include drooping eyelidsfacial expression changesdifficulty chewing and swallowing, speaking issues, breathing difficulties, and weakness in the arms and legs. Symptoms may improve with rest but worsen with activity. Over time, the condition can worsen, significantly affecting the patient's quality of life.

Figure 5: Myasthenia Gravis Patient Symptoms

Diagnosis and Testing

Doctors usually diagnose myasthenia gravis through the following methods:

  1. Observing eyelid drooping: The patient closes their eyes, and within 30 seconds, the eyelids may part, revealing the whites of the eyes due to muscle weakness.

  2. Ice pack test: An ice pack is placed on the patient's eyes to see if the drooping improves. Improvement may indicate myasthenia gravis.

Figure 6: Drooping Eyelids Observation - When the patient closes their eyes, the eyelids will separate, exposing the white of the eye

Figure 7: Ice pack test for muscle weakness-tests whether the eye muscles relax

Treatment and Management

Treatment for myasthenia gravis varies but often includes the following medications:

  1. Cholinesterase inhibitors: Improve muscle function.

  2. Steroid medications: Such as Prednisone.

  3. Immunosuppressants: Such as Cyclosporine, Mycophenolate Mofetil, Azathioprine.

Most patients can manage their immune system and muscle activity with medication, improving their quality of life. However, severe cases may face complications such as rheumatoid arthritis, lupus, or breathing difficulties due to muscle weakness.

Recent Research and Preventive Measures

Recent advancements in myasthenia gravis research have shown promising results. For example, Vyvgart is now used to treat patients with anti-acetylcholine receptor (AChR) antibodies. Additionally, other medications controlling immune system disorders are being researched and applied.


Conclusion

Myasthenia gravis is a serious disease that can persist throughout a patient’s life, posing risks like respiratory muscle weakness, difficulty swallowing, and muscle control problems. Patients should seek medical attention promptly, use the ice pack test, and monitor their eyelids for signs of the disease. Maintaining a positive outlook and following a healthy diet can help prevent complications and manage the disease effectively.


Work Cited

“Myasthenia Gravis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 22 June 2023, www.mayoclinic.org/diseases-conditions/myasthenia-gravis/symptoms-causes/syc-20352036

“Myasthenia Gravis.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/health-information/disorders/myasthenia-gravis. Accessed 30 April 2024. 

“Myasthenia Gravis | MG.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/myastheniagravis.html. Accessed 30 April 2024. 

Commissioner, Office of the. “FDA Approves New Treatment for Myasthenia Gravis.” U.S. Food and Drug Administration, FDA, www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-myasthenia-gravis. Accessed 30 April 2024. 

“Myasthenia Gravis.” Myasthenia Gravis | Office on Women’s Health, www.womenshealth.gov/a-z-topics/myasthenia-gravis. Accessed 30 April 2024. 

Cleanthous, Sophie, et al. “Development of the Myasthenia Gravis (MG) Symptoms pro: A Case Study of a Patient-Centred Outcome Measure in Rare Disease.” Orphanet Journal of Rare Diseases, U.S. National Library of Medicine, 30 Oct. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8556940/.

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