Myasthenia Gravis

Myasthenia gravis (MG) is an autoimmune disorder in which antibodies block the communication between nerves and muscles at the neuromuscular junction. It causes fluctuating weakness — worse with use, better with rest — of specific muscle groups (eye, face, throat, neck, limbs, breathing muscles). With modern treatment, most people with MG live full, active lives.

Classic features

• Drooping eyelids (ptosis), double vision — often the first sign.
• Weakness that worsens through the day and with repetition.
• Slurred speech, nasal voice, difficulty chewing/swallowing.
• Neck and limb weakness — particularly proximal (shoulder/hip).
• Breathing difficulty in severe cases (myasthenic crisis — emergency).

Red flags — dial 112

• Worsening breathing, swallowing, or inability to clear saliva — myasthenic crisis; ventilator support may be needed.
• Rapidly progressive weakness.
• Choking or aspirating food.

Diagnosis

• Clinical examination, including fatigue tests.
• Anti-acetylcholine receptor antibodies, anti-MuSK antibodies, anti-LRP4 — blood tests.
• Electromyography (repetitive nerve stimulation, single-fibre EMG).
• CT chest — for thymoma (abnormal thymus gland; present in some MG patients).
• Rule out thyroid disease and other autoimmune conditions often associated.

Treatment

• Cholinesterase-inhibitor tablets — symptomatic relief.
• Steroids, steroid-sparing immunosuppressants — mainstay for disease control.
• Intravenous immunoglobulin (IVIG), plasma exchange — for severe flares or crises.
• Biologics and newer targeted therapies — for refractory disease; increasingly available at specialist centres in India.
• Thymectomy — surgical removal of the thymus; indicated for thymoma; also improves outcomes in selected non-thymoma generalised MG.
• Avoid medicines that worsen MG — some antibiotics (quinolones, aminoglycosides), magnesium sulphate, certain muscle relaxants, certain heart medicines (beta-blockers can sometimes), specific imaging contrast agents. Keep a list; carry it; tell every Health Expert about your diagnosis.

Living with MG

Pace activities; sleep adequately; treat infections and stress promptly; vaccinations (flu, pneumococcal); monitor for thyroid disease. Indian Myasthenia Gravis Association and specialist clinics provide support and information.