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Myasthenia Gravis

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Myasthenia gravis is an autoimmune disease that causes muscle weakness that worsens with activity and improves with rest. Normally, the neurotransmitter acetylcholine stimulates muscular contractions. In most patients with myasthenia gravis, the immune system produces antibodies that block the acetylcholine receptor in muscle cells.

Some integrative therapeutics, such as vitamin D3, astragalus, and creatine may provide benefits or ease symptoms of myasthenia gravis.

Causes and Risk Factors

  • Women are more likely than men to develop this autoimmune disease, and at a younger age.
  • Ten to fifteen percent of people with myasthenia gravis have a thymic tumor, and 50% have an increased number of cells in the thymus.
  • Infection with the Epstein-Barr virus and inflammation may contribute to the development of myasthenia gravis.

Signs and Symptoms

  • Muscular weakness that progressively gets worse with prolonged exercise and is often more pronounced in the evening.
  • First symptom is generally eye muscle weakness, which can affect up to 85% of affected individuals. In 15% of patients, the initial symptom is difficulty swallowing and slurred speech.
  • Patients may also have blurred or double vision, drooping eyelids, or changes in facial expression and control.

Diagnosis

  • Peek sign: The patient closes their eyes and, due to weakness of the eye muscles, the eyelids separate within 30 seconds to reveal the whites of the eye.
  • Ice pack test: In patients with drooping eyelids, an ice pack is placed over the patient’s eye. If the patient has improvement in double vision or drooping eyelids after the ice pack is removed, they likely have myasthenia gravis.
  • Physicians can perform analyses of blood samples to detect self-reacting antibodies.

Conventional Treatment

  • The primary long-term treatment strategy for myasthenia gravis is suppression of the immune system, usually with corticosteroids and non-steroidal drugs.
  • Acetylcholinesterase inhibitors, plasma exchange and intravenous immunoglobulin therapy are other therapies used for myasthenia gravis.

Note: Although rare, certain drugs may either induce symptoms of myasthenia gravis or aggravate existing symptoms, including penicillamine, intravenous magnesium, some antibiotics, and beta-blockers.

Novel and Emerging Strategies

  • Several clinical trials have reported that rituximab, which is used for rheumatoid arthritis, may be effective for the treatment of myasthenia gravis.
  • A phase II study showed that eculizumab, which inhibits a certain aspect of the immune system (the complement system), reduced symptoms of myasthenia gravis more than placebo.
  • Granulocyte macrophage colony-stimulating factor (GM-CSF) may be an effective treatment option for myasthenia gravis as it can enhance the activity of regulatory T cells.

Dietary and Lifestyle Considerations

  • As muscle fatigue can make eating a difficult task, doctors recommend eating during periods when patients have more strength and eating 5–6 small meals throughout the day.
  • Several studies suggest exercise may improve muscle fatigue and weakness in patients with neuromuscular diseases, including myasthenia gravis. However, it is critical that those with myasthenia gravis do not over exercise, as this could exacerbate symptoms.

Integrative Interventions

  • Vitamin D: A pilot study showed supplementation with vitamin D has beneficial effects on autoimmune response and may alleviate fatigue associated with myasthenia gravis.
  • Astragalus: Astragalus was found to be as effective as prednisone for reducing symptoms of myasthenia gravis.
  • Creatine: An analysis of six randomized controlled trials in muscle diseases reported that patients who supplemented with creatine had a significant improvement in muscle strength versus placebo-treated patients.
  • White peony extract: Peony has been found to have immune-modulating properties, which may be helpful with the underlying pathology of myasthenia gravis.
  • Fish oil: Due to its anti-inflammatory and immune-modulating properties, fish oil may help with the underlying pathology of myasthenia gravis.