Myasthenia Gravis Hits Nerve/Muscle Juncture

DEAR DR. ROACH: What can you tell me about myasthenia gravis? My dear friend was diagnosed with it and hospitalized for eight days. She is able to walk and move about, but now, six weeks later, she is still on a liquid diet and unable to move any of her facial muscles. -- I.M.

ANSWER: Myasthenia gravis, from the Latin and Greek for “serious muscle weakness,” is an autoimmune disease that attacks the connection of nerves to muscles. Specifically, the body attacks the acetylcholine receptor or its associated proteins, where nerves connect to skeletal muscles. This causes weakness of the muscles and increased susceptibility to fatigue.

The diagnosis of MG is suggested by typical symptoms, the most common of which are eye symptoms like double vision or droopy eyelid (ptosis). 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 is usually confirmed by blood testing, but a few people will need more sophisticated testing, such as an electrical muscle stimulation test.

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 is often performed to improve symptoms.

In addition to removal of the thymus, there are three other types of treatment for MG. The first is medicines that help the nerve-muscle receptor work better, such as pyridostigmine. 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. It’s not clear exactly how these work in MG. 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.

You can read more NIHmyasthenia.

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DEAR DR. ROACH: I read that people are not being paid for donating blood anymore. Is this true? -- R.F.T. at www.tinyurl.com/

ANSWER: Yes. Blood donation is not compensated. Plasma donation, on the other hand, often is compensated. Plasma, which contains the proteins in the blood, can be highly purified so that there is no risk of infection, as opposed to blood -- every precaution is taken to reduce infection, but it can never be brought to zero.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu.

1. What South African golfer completed the second-place career Grand Slam -- finishing second in all four majors -- with his runner-up finish at the 2017 PGA Championship?

2. National Baseball Hall of Fame pitcher Early Wynn Jr. retired in 1963 with how many career wins?

3. In 1991, Los Angeles Kings owner Bruce McNall, hockey great Wayne Gretzky and actor/ comedian John Candy jointly purchased what pro football team?

4. A motorsport circuit named after Formula One driver Carlos Pace, who died in a 1977 plane crash, is located in what country?

5. Name the starting quarterback for the 1964 NFL champion Cleveland Browns who also produced a doctoral dissertation titled “A Characterization of the Set of Asymptotic Values of a Function Holomorphic in the Unit Disc.”

6. In 2020, what team hired Kim Ng as the first female general manager in Major League Baseball history?

7. What famous Seattle rock band was originally named after NBA player Mookie Blaylock?

Answers

1. Louis Oosthuizen.

2. 300.

3. The CFL’s Toronto Argonauts.

4. Brazil.

5. Frank Ryan.

6. The Miami Marlins.

7. Pearl Jam.