What is Myasthenia Gravis?
Myasthenia gravis is a disease characterised by a loss of control in movements of the skeletal muscles in the body. In this disease the muscles of the body stops responding to the signal from the nerves. This results in uncontrolled movements of these muscles without proper coordination.
The most common muscles affected are those of the face, neck and limbs. The intercostals or respiratory muscles are also affected to a lesser degree. The characteristic features of the disease include drooping of the eyelids, tremor like movements of the limbs etc. The disease can occur at any age and is also seen in infants. Typically women below the age of forty and men above the age of sixty are more commonly affected.
The disease is autoimmune in origin. That means the disease occurs due to a fault in the body’s immune system. The antibodies produced by the immune system interfere with the transmission of the impulses from the nerves to the muscles.
Myasthenia gravis causes:
The body consists of various types of muscles, with skeletal and smooth muscles being the most common ones. A majority of the skeletal muscles respond only to voluntary movements, while all the smooth muscles are involuntary in nature. For a muscle to move there should be a proper coordination of the nerves and the muscles. The brain sends signal to the muscles to move through the nerves. Once the muscles receive the signals they move as directed by the brain. The muscles contain certain receptors on their surfaces to receive the signals. The neurons on the nerves release certain chemicals called neurotransmitters that carry messages from the brain. These neurotransmitters bind to the receptors on the muscle surfaces to transmit the message.
The most common type of neurotransmitter is a chemical called acetyl choline. In myasthenia gravis the body produces certain antibodies that bind to the acetyl choline receptors in the muscles. This prevents acetylcholine from binding to the receptors causing a loss of transmission from the nerves. The lack of innervation affects the movements of the muscles resulting in uncontrolled or improper movement characteristic of myasthenia gravis.
The antibodies are produced due to an over activity of the thymus gland. Thymus gland is located behind the breast bone and is active during the childhood. As age progresses the thymus gland reduces its activity and becomes virtually inactive during adulthood. But in certain persons the gland remains active and keeps on producing certain antibodies. This is more so in persons with myasthenia gravis.
Myasthenia gravis symptoms
The symptoms of the disease occur due to a weakness of the skeletal muscles that control voluntary activities. The muscles of facial expression are most commonly affected followed by other muscles. The symptoms may appear suddenly making it difficult to differentiate from certain acute conditions with similar symptoms.
The most common symptoms are:
• Drooping of the eyelids or ptosis. This may be confined to one eye or may affect both.
• Improper or uncontrolled facial expressions
• Blurring of vision
• Impairment or difficulty in speech
• Difficulty in swallowing
• Regurgitation of food through the nose
• Weakness of the hands and legs
• Weakness of the neck muscles
• Difficulty in breathing
Myasthenic crisis is a complication of the disease. In this condition the muscle that control respiration becomes very weak. The patient may require the assistance of a ventilator to breathe. This condition may be triggered by stress, trauma, certain surgeries and medications.
Myasthenia gravis diagnosis:
The diagnosis of the condition is based on various tests. These tests also provide an idea about the intensity of the disease and the course taken by it.
Neurological examination to assess the strength, reflexes, tone, coordination and balance of the muscles is the preliminary diagnostic test.
Other confirmatory diagnostic tests include:
• Edrophonium test-The administration of edrophonium chloride may result in a sudden and transient improvement in muscle tone which is an indication of the disease.
• Ice pack test- An icepack is applied over the eyelid that has drooped. An improvement albeit temporary is indicative of the disease.
• Blood tests - are done to detect the presence of certain abnormal antibodies
• Repetitive nerve stimulation test
• Electromyography (EMG) test
• CT or MRI scans to detect abnormalities of thymus
• Pulmonary function tests- to assess the involvement of respiratory muscles
Myasthenia gravis Treatment:
The aim of the treatment is to reduce the intensity of the symptoms.
Medications- Anticholinesterase drugs that slows down the breakup of acetyl choline is the primary drug of choice. The drug thus helps to prolong the action of acetylcholine leading to an increase in neuromuscular coordination.
Immuno-suppressants are administered to reduce the immunity levels. This helps to decrease the amount of antibodies in the blood that act against acetylcholine. Corticosteroids are the most common type of drug used. Long term use of the drug may create adverse side effects that should be looked into periodically.
Thymectomy- This is a surgical operation to remove the thymus gland. Since an overactive thymus gland is found to contribute to the disease, its removal helps to regulate the immune system. There is a significant fall in the levels of antibodies after the surgery which helps to improve the disease condition.
Plasmapheresis - This is a procedure by which the antibodies that affect the neuromuscular junction are removed from the blood plasma. The procedure is similar to that of a dialysis. The blood is taken out to a machine that filters the antibodies and then infused back into the body. The major drawback is that this needs to be repeated periodically and not as a one off procedure.
Intravenous immunoglobulin administration- In this procedure antibodies sourced from healthy donors is infused into the body. These antibodies regulate the immune system by removing the abnormal antibodies produced by the patient’s body.
A myasthenic crisis requires emergency medical treatment. The first step of Myasthenia gravis crisis treatment is to provide ventilator support to the patient. This is then followed up by medications to control the situation.
Myasthenia gravis treatment in Ayurveda:
Myasthenia gravis symptoms can be controlled through certain ayurvedic treatment modalities. The aim of ayurvedic treatment is to rejuvenate the body as a whole while treating the disease specifically.
According to Ayurveda, any disease occurs due to an imbalance of the three doshas namely vata, pitta and kapha. In ayurvedic prognosis Myasthenia gravis is a vata predominant disease. There is also a deficiency of ojas, a factor that have a direct bearing on the immunity of the body. The aim of ayurvedic treatment is to restore the balance of the three doshas. A vata pacifying treatment schedule that also helps regulate the immune system is recommended for the disease.
Various ayurvedic treatments like panchakarma are prescribed to restore the balance of the doshas. The treatment schedule is programmed according to the intensity of the disease and the constitution of the patient. A specific diet is also prescribed during and after treatment to avoid aggravating factors through food.
The duration of myasthenia Gravis treatment in Ayurveda is 21-28 days in the hospital and the cost for this would be in the range of 1,300 to 3,800 USD