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Myasthenia Gravis

Myasthenia gravis (MG) is a chronic neuromuscular condition that causes weakness in voluntary muscles (skeletal muscles) that worsens with activity and improves with rest. It is caused by an abnormal response in the immune system.

Overview

The weakness occurs when the nerve impulses that initiate or sustain movement do not adequately reach the muscle cells because the immune system targets the body's own cells. This is called an autoimmune response. An immune system produces antibodies that attach to one’s own cells, which prevents muscles from receiving the message from the nerves.

Myasthenia gravis can occur at any time, but is more common in young women and older men.

Symptoms

The earliest symptoms of myasthenia gravis usually affect vision and include:

  • Double vision
  • Difficulty maintaining a steady gaze
  • Eyelid drooping

Other symptoms include:

  • A drooping head
  • Difficulty breathing
  • Difficulty chewing and swallowing
  • Difficulty climbing stairs
  • Difficulty talking
  • Facial paralysis
  • Difficulty lifting objects
  • Hoarseness
  • Difficulty standing from a seated position
  • Muscle weakness that improves with rest
  • Gagging or choking

Causes

The cause of myasthenia gravis is unknown.

Factors that can make myasthenia gravis worse include:

  • Fatigue
  • Illness
  • Stress
  • Extreme heat
  • Some medications, including beta-blockers, calcium channel blockers, quinine, and some antibiotics

Diagnosis

The first method of diagnosis is the physical exam and medical history. The main indication of myasthenia gravis is weakness that worsens with activity and improves with rest. Tests that the physician may order to confirm a diagnosis include:

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Treatment

Doctors use a variety of treatments—alone or in combination—to relieve symptoms of myasthenia gravis.

Treatment for myasthenia gravis includes:

  • Medication, including cholinesterase inhibitors, corticosteroids and immunosuppressants
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There are several techniques for performing a thymectomy, including:

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  • Robotic thymectomy. The surgeon makes three tiny incisions, usually on the left side of the chest. A small camera and robotically controlled surgical instruments are advanced through these incisions. The surgeon’s hand movements control the robotic instruments using a control console and computer. The benefits of robotic thymectomy include briefer hospital stays, less pain and risk of infection, and faster healing and recovery time.
  • Transsternal radical thymectomy. The surgeon makes a lengthwise incision in the center of the chest and separates the breastbone (sternum) to gain access to the chest. The thymus is then removed. This procedure is performed under general anesthesia, and is the most invasive form of thymectomy and requires the longest recovery time.