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Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by fatigue and varying degrees of episodic weakness of the voluntary muscles. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Facial muscles and those involved in chewing, talking, and swallowing are often, but not always, involved. The muscles that that control breathing and neck and limb movements may also be affected.
Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. In myasthenia gravis, antibodies produced by the body's own immune system block, alter or destroy the receptors for acetylcholine.
Causes & Development
Myasthenia gravis is not directly inherited nor is it contagious.
Signs & Symptoms
The first noticeable symptoms of myasthenia gravis may be weakness of the eye muscles, difficulty in swallowing, or slurred speech. Symptoms vary in type and severity. The onset of the disease involves only eye symptoms in 40% of patients, is generalized in 40%, and affects only the extremities in 10% (muscles close to joints are more severely affected than those further away). As the disease progresses, the weakness often spreads over the entire body. After the first year with myasthenia gravis, almost all patients have eye involvement, and in cases where the disease is destined to become generalized 90% will have become so involved. In 16% of patients only the eyes will ever be involved. During the first three years the progression of the disease is rapid and most deaths occur during this time. Myasthenia gravis occurs at all ages, usually between the ages of 20 and 40. If thymoma is associated, older men are more commonly affected.
Onset is usually slow, but the disorder is sometimes unmasked by a coincidental infection that leads to a worsening of symptoms. Exacerbations may also occur before the menstrual period and during or shortly after pregnancy.
Diagnosis & Tests
Several diagnostic tests are available to confirm the diagnosis, including a special blood test that can detect the presence of immune molecules or acetylcholine receptor antibodies.
Prognosis; Complications
With conventional treatment, the outlook for most patients with myasthenia is bright: they can expect to lead nearly normal lives. Some cases of myasthenia gravis may go into remission temporarily, and muscle weakness may disappear so that medications can be discontinued.
In a few cases, the severe weakness of myasthenia gravis may cause respiratory failure, which requires immediate emergency medical care.
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Signs, symptoms & indicators of Myasthenia Gravis:
Conditions that suggest Myasthenia Gravis:
Risk factors for Myasthenia Gravis: | | | | | Autoimmune |  Autoimmune Tendency |
Tumors, Benign |
 Thymoma | About 15% of patients with myasthenia gravis are found to have a tumor of the thymus gland, known as a thymoma. Most thymomas are benign. Also, about 50% of patients with thymoma are found to have myasthenia gravis. |
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Recommendations and treatments for Myasthenia Gravis: | | | | | Diet |  Gluten-free Diet| | Autoimmune diseases in general have a higher prevalence of gluten intolerance. A one-month trial period of avoiding dairy products and foods containing gluten/gliadin should indicate whether there is going to be any change in symptoms or lab values in individual patients. If there are improvements then these foods will need to be avoided on a permanent basis. |
Dairy Products Avoidance| | See discussion of Myasthenia Gravis and Gluten-free Diet. |
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Digestion |
 Hydrochloric Acid (Trial)| | Stomach acid levels are generally lower in patients with autoimmune diseases. Inadequate digestion can add to the immune system malfunction. |
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Drug |
 Conventional Drug Use| | Conventional medicine can control myasthenia gravis. Some medications improve neuromuscular transmission and increase muscle strength, and some suppress the production of abnormal antibodies. These medications must be used with careful medical supervision because they may cause major side effects. |
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Habits |
Tobacco Avoidance| | Dr. Fred Klenner, MD claims that patients with myasthenia gravis will hinder their progress if they use tobacco. |
Aerobic Exercise| | Available literature indicates that patients with myasthenia gravis may benefit from both a strengthening as well as an aerobic/cardiovascular fitness program. Patients should be taught a home exercise program that is individualized for their limitations and tolerance. Physical training is safe for patients with mild myasthenia gravis and does produce some improvement in overall muscle strength.
Walking for short periods at a slow pace is a good way to start a walking program. Increase the exercise time slowly until you build up to 30 minutes of continuous walking. If you are comfortable with this, then your speed can slowly be increased. Before beginning any exercise program, please check with your doctor for advice on whether this is appropriate for you, and what form of exercise is preferred. |
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Lab Tests/Rule-Outs |
Test for DHEA| | DHEA is almost always low in patients with autoimmune conditions such as myasthenia gravis. |
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Mineral |
Potassium| | The weakness of myasthenia gravis may be improved by potassium consumption, if dietary potassium is low. |
Manganese| | Manganese deficiency has been linked to myasthenia gravis. Manganese activates several enzyme systems and supports the utilization of vitamin C, E, choline, and other B-vitamins. Inadequate choline utilization reduces acetylcholine synthesis, contributing to conditions such as myasthenia gravis. |
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Nutrient |
Essential Fatty Acids
Lecithin / Choline| | To increase acetylcholine levels add phosphytidal choline (lecithin) 1gm bid. |
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Physical Medicine |
Rest| | Sufferers should get plenty of rest and adjust their activities to avoid unnecessary fatigue. This may include resting frequently as necessary during the day. |
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Psychological |
Stress Management| | Emotional stress, excessive heat and cold, fever, and exposure to infections can worsen symptoms and should be avoided whenever possible. |
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Surgery/Invasive |
Surgery| | The thymus is thought to play an important role in the development of the disease by supplying helper T cells sensitized against thymic nicotinic receptors. In most patients with myasthenia gravis, the thymus is enlarged, and 10-15% have thymomas. Thymectomy is indicated if a thymoma is suspected. In patients with generalized myasthenia without thymoma, thymectomy induces remission in 35% and improves symptoms in another 45%.
The thymus is the master gland of immunity, and removing this gland weakens the body's ability to fight infections and cancer. The thymus normally shrinks and becomes less useful with age. It would seem logical that thymectomy in a younger person could have greater negative long term consequences than thymectomy in an older person. |
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Vitamins |
Vitamin B12 (Cobalamine)
Vitamin B5 (Pantothenic Acid)| | To enhance acetylcholine levels take pantothenic acid 100mg daily. There is sufficient evidence to believe that coenzyme A, which is the physiologically active form of pantothenic acid in animals, is in limited supply in cases of myasthenia gravis. |
Vitamin B1 (Thiamine)| | To enhance acetylcholine levels take thiamine 100mg daily. Additionally, Dr Fred Klenner, MD stresses the importance of thiamin in treating myasthenia gravis and recommends its use by injection. From 30 years of experimentation he concludes that this is not a vitamin deficiency disease but one of several vitamin-dependent diseases, where the successful treatment requires dosages up to 1,000 times the minimal daily requirement that has been established for thiamin. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acetylcholine
A neurotransmitter widely distributed in body tissues with a primary function of mediating synaptic activity of the nervous system and skeletal muscles.
Aerobic (Aerobically)
Using oxygen. For example, aerobic exercises such as running, swimming, bicycling or playing tennis use up lots of oxygen and burn up lots of calories and fat.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous; they tend to grow slowly and don't spread (metastasize) like cancer tumors do.
BID
Twice per day.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cardiovascular
Pertaining to the heart and blood vessels.
Choline
A lipotropic substance sometimes included in the vitamin B complex as essential for the metabolism of fats in the body. Precursor to acetylcholine, a major neurotransmitter in the brain. Choline prevents the deposition of fats in the liver and facilitates the movement of fats into the cells. Deficiency leads to cirrhosis of the liver.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Coenzyme
A heat stable molecule that must be associated with another enzyme for the enzyme to perform its function in the body. It is necessary in the utilization of vitamins and minerals.
DHEA (DHEA-S)
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Essential Fatty Acid (EFA, EFAs, Essential Fatty Acids)
A substance that the human body cannot manufacture and therefore must be supplied in the diet.
Fatty Acids (Fatty Acid)
Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Myelin
A substance made of protein and lipid (fat) that protects the nerves, especially in the brain. The myelin sheath is a jacket of insulation around axons to help them conduct their electrical discharges quickly down the axon.
Neurotransmitters (Neurotransmitter)
Chemicals in the brain that aid in the transmission of nerve impulses. Various Neurotransmitters are responsible for different functions including controlling mood and muscle movement and inhibiting or causing the sensation of pain.
Pantothenic Acid
A B-complex vitamin necessary for the normal functioning of the adrenal gland, which directly affects growth. It is also essential for the formation of fatty acids. As a coenzyme, it participates in the utilization of riboflavin and in the release of energy from carbohydrates, fats and proteins.
Sublingual (Sublingually)
Situated or administered under the tongue, for example sublingual glands or sublingual tablets.
Thiamine (B1, B-1, Thiamin, Vitamin B1)
A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.
Thymoma
A tumor of the thymus, an organ that is part of the lymphatic system and is located in the chest, behind the breastbone.
Thymus (Thymus Gland)
This soft, pinkish-gray gland is tucked behind the sternum between the lungs, shrinks as we come to puberty, and may even atrophy later on. The thymus helps the immune system adapt to various threats. For example, "T" cells are white blood cells that have been activated by the thymus; hence the letter "T". The thymus also produces a number of different compounds that help strengthen the immune system. It increases in size until puberty to approximately 20-50gm and then undergoes progressive atrophy to 5-15gm in older patients. The thymus is the site where bone marrow progenitor cells migrate and differentiate into T-cells. Prothymocytes in the superficial cortex (CD2) give rise to cortical thymocytes (CD1a, CD2, CD3) and CD4 and CD8 (T-helper and -suppressor cells). There are also scattered epithelial cells, macrophages, dendritic cells, and myoid cells. The thymus appears to need plenty of balanced protein, antioxidants like carotenes, vitamin C, E, B6, zinc and selenium.
Last updated: Nov 14, 2009
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