Myasthenia Gravis

Myasthenia Gravis: Overview

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 control breathing and neck and limb movements may also be affected.

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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 and Development

Myasthenia gravis is not directly inherited nor is it contagious.

Signs and 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 and 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.

Signs, symptoms & indicators of Myasthenia Gravis:

Lab Values - Cells

Symptoms - Environment

(Minor/severe) cold weather muscle weakness

Very cold (or very hot) weather may increase weakness in myasthenia gravis patients.

Counter-indicators
No cold weather muscle weakness

Very cold (or very hot) weather may increase weakness in myasthenia gravis patients.

Symptoms - Muscular

Conditions that suggest Myasthenia Gravis:

Symptoms - Muscular

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Risk factors for Myasthenia Gravis:

Autoimmune

Autoimmune Tendency

About 5-10% of patients with myasthenia gravis also have other autoimmune diseases.

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.

Myasthenia Gravis suggests the following may be present:

Autoimmune

Autoimmune Tendency

About 5-10% of patients with myasthenia gravis also have other autoimmune diseases.

Recommendations 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.

Digestion

Hydrochloric Acid (Trial)

Stomach acid levels are generally lower in patients with autoimmune diseases.  Inadequate digestion can add to the immune system malfunction.

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.

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.

Lab Tests/Rule-Outs

Test for DHEA

DHEA is almost always low in patients with autoimmune conditions such as myasthenia gravis.

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.

Nutrient

Essential Fatty Acids

Essential fatty acids have been shown to suppress autoimmune attacks in general and to help protect myelin sheaths.  A blend of omega-3 and omega-6 fatty acids may provide supportive benefit in the treatment of myasthenia gravis

Lecithin / Choline

To increase acetylcholine levels add phosphatidylcholine (lecithin) 1gm bid.

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.

Psychological

Stress Management

Emotional stress, excessive heat and cold, fever, and exposure to infections can worsen symptoms and should be avoided whenever possible.

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.

Vitamins

Vitamin B12 (Cobalamine)

To enhance acetylcholine levels take vitamin B12 1000mcg sublingually each day.

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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