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What is Myasthenia Gravis?

What is Myasthenia Gravis?Myasthenia gravis is the most common disorder of nerve-conduction. It is also one of the best defined and understood autoimmune disorders.

Myasthenia gravis is a relatively rare disease. The incidence rate in a year is approximately between 7 and 23 per million Dec. The most distinguishing feature of the disease is the weakening of the muscles that help in the exchange of eyes, jaw, limbs and breathing with varying degrees and combinations. The reason for this weakening is the attack of immune system cells against proteins located in the so-called neuromuscular junction, where transmission from nerves to muscles takes place. Clinical and serological tests are used in the diagnosis.3 myasthenia gravis, which can cause disability and can be fatal sometimes called antikolinesteraz drugs in the treatment of disease, plasmapheresis or intravenous immunoglobulin therapy, chronic immune system-suppressing drugs or timektomi (removal of the thymus) surgery can be applied. Treatment varies depending on the age of the patients, the severity or course of the disease, and whether it affects breathing or neck muscles..

What are the Symptoms of Myasthenia Gravis?
The Myasthenia gravis is the most common symptom of myasthenia gravis, which is a weakening of the skeletal system muscles and often actual muscle fatigue. fatigue fatigue occurs due to a decrease in the contractile power of the muscles, rather than the feeling of fatigue. In patients experience fatigue in specific muscles instead of general muscle fatigue. But this muscle weakening and fatigue that occurs in certain muscles typically varies. This change can occur throughout the day, as well as after exercise, or in the form of worsening during the day or evening. Although there is usually no symptom-free period in the disease process, periods when the symptoms are mild or severe may occur. These symptoms, which occur in the muscles, can manifest in different ways:
* Complaints such as low eyelid, double vision or blurred vision may occur due to the muscles around the eyes and the eyelid being affected.
* Complaints such as difficulty chewing food and fatigue due to the muscles in the jaw and neck area, difficulty swallowing and swallowing, difficulty during speech may occur. In addition, symptoms such as a feeling of heaviness in the head or a forward fall of the head may also appear.
* Complaints such as difficulty breathing and shortness of breath may occur due to the muscles used in breathing. Depending on the effect of these muscles, life-threatening may occur.
* As a result of weakening of the muscles in the limbs, difficulty in opening the fingers, lifting the foot, moving the arms and legs occur.

How is Myasthenia Gravis Diagnosed?
In order to diagnose myasthenia gravis, clinical evaluation is performed first. It is of great importance to have typical signs of myasthenia gravis and to question the medical history. The sensitivity of the bedside tests used in the diagnosis (ice bag test) is high, but they are not diagnostic tests because they can also give a positive result in those who do not have myasthenia gravis disease. The most reliable methods for confirming the diagnosis are laboratory serological tests and electrophysiological studies (single fiber EMG and repetitive nerve stimulation).
*  Ice pack test: It can be applied as part of the neurological examination in patients with ptosis. Depending on the principle of better nerve-to-muscle conduction at low muscle temperature, in myasthenia patients with droopy eyelids, an ice pack is placed on the area and the eyelid muscles are observed to work. In this test, a bag or glove is filled with ice and left on the closed eyelid for two minutes. Then, the bag is removed and droopy eyelid is observed. Ptosis test result.
* Serological tests: The formation of autoantibodies in the blood is observed. A high rate of positive results is obtained, especially in the case of all generalized (affecting most parts of the body) diseases. In myasthenia gravis, which affects only the eye area, the sensitivity is lower.
* Electrophysiological studies: Repetitive nerve stimulation is a commonly used test in the diagnosis of myasthenia gravis. With electrodes placed on the body, the nerve cell is stimulated 6 to 10 times at a low speed and the action potential of the muscle is recorded. Single fiber EMG, on the other hand, is a more technical test than repetitive nerve stimulation. In addition, it is the method with the highest sensitivity in the diagnosis of myasthenia gravis. It is made by simultaneously recording the action potentials of two fibers stimulated by the same nerve cell.

What are the Treatment Methods for Myasthenia Gravis?
The treatments used to treat Myasthenia Gravis consist of four different categories.
1.Symptomatic treatment (acetylcholinesterase inhibition): The amount of a molecule called acetylcholine, which is located at the neuromuscular junction and helps to transfer the message from the nerve to cells, is increased with the drugs used. Drugs containing the active substance pridostigmine and neostigmine are used. Pridostigmine is the first choice treatment method in mild or moderate myasthenia gravis disease.
2.Chronic immunosuppressive (Immunosuppressive) therapies: Glucocorticoids and non-steroidal immunosuppressive drugs are used. Thanks to these drugs, the immune system and autoimmune disease can be suppressed. Drugs containing the active substances azathioprine, mycophenolate are included in this group.
3.Fast but short-acting immunomodulatory therapies: Used in case of severe illness. Plasma exchange therapy and intravenous immunoglobulin (IVIG) therapy are included in this group. Although the effect is short-lived, it is one of the treatment methods that shows rapid effectiveness.
4.Surgical treatment (Thymectomy): In thymectomy surgery, the thymus is completely removed. In some patients selected in parallel with pridostigmine therapy and immunosuppressive therapy, thymectomy shows benefit in treatment.

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