Myasthenia gravis attacks nerve-muscle connection

A smaller number of people will have symptoms that involve eating and chewing — this sounds like your friend’s primary problem — and a few will have weakness in the limbs, neck or face, or of the breathing muscles. The diagnosis usually is confirmed by blood testing.

MG commonly affects women under 40 and men over 60, but it can occur in any age group. The thymus, an immune organ that is located in the upper chest behind the sternum (breastbone), is an important origination point for MG, and 10% to 15% of people with MG have tumors of the thymus. Surgical removal of the thymus often is performed to improve symptoms.

In addition to removal of the thymus, there are three other types of treatment for MG. The first involves medicines, such as pyridostigmine, that help the nerve-muscle receptor work better. This starts working within minutes. The second is treatments to get rid of the antibodies attacking the receptor. Plasmapheresis, the physical removal of antibodies, takes a few days to start working; intravenous immune globulin takes a week or two to work. The third type, anti-immune system drugs, take much longer: a few weeks for prednisone but several months at least for others, such as cyclosporine and mycophenolate.

Your friend is in a period where many of the treatments have not had time to work yet, and I expect that she will get better as the treatments take hold. Her doctors may be talking to her about removing the thymus, but she needs to be well-controlled before surgery. Some experts use plasmapheresis or immune globulin to get good control quickly before surgery, especially in people whose symptoms involve eating and facial functions.