Monday, November 28

Myasthenia gravis: when the enemy is our own defenses

Fatigue or tiredness that worsens throughout the day and improves with rest. Broadly speaking, myasthenia gravis is expressed like this, and affects above all to the muscles that move the eyes, although they are not the only ones.

In Spain, although the myasthenia gravis it is rare, affects about 15,000 people. According to the Spanish Society of Neurology (SEN), each year 700 new cases of this autoimmune disease are diagnosed, which is expressed as a self-attack due to a system error at the junction between nerves and muscles.

This disease usually develops in women between 20-40 years and in men between 50-80 years, but it can affect at any age (rarely it starts in childhood).

What are the causes of myasthenia gravis?

Under normal conditions, nerves communicate with muscles through the release of chemicals (neurotransmitters) that fit into muscle cell receptors at the neuromuscular junction. This allows nerve signals to prompt muscles to move.

In myasthenia gravis, the immune system produces antibodies They block many of the receptors in the muscles for a neurotransmitter called acetylcholine. Thus, the connection between the nerve and the muscle is interrupted. This causes the muscles to weaken because they receive fewer nerve signals.

Although it is unknown what causes the body to attack its own acetylcholine receptors, there is a theory that suggests that the malfunction of the thymus gland, a small organ located in the upper chest, under the breastbone, may be involved. In this gland, certain cells of the immune system learn to differentiate between the body and foreign substances.

What are the symptoms of myasthenia gravis?

There are two clinical forms of myasthenia gravis: ocular and generalized. In the eye, the most common symptoms include:

  • Weakness of the muscles that control the eye, eyelid, and other muscles that control eye movement (extraocular muscle).
  • Partial paralysis of eye movements.
  • Double vision and drooping eyelids.
  • Weakness and fatigue in the neck and jaws, with problems chewing, swallowing, and holding up the head.

In the generalized form, myasthenia gravis weakens not only the eye muscles but also a variable combination of muscles in the arms, legs, and respiratory muscles.

When common muscle groups are affected, actions such as chewing, swallowing, smiling, shrugging, raising the arm, picking things up, standing up, or climbing stairs are difficult to perform.

This weakness usually increases during periods of activity and improves after a period of rest. The symptom fluctuation it is an important feature that allows neurologists to distinguish myasthenia gravis from other disorders.

Treatment for myasthenia gravis

Though there is no cure for myasthenia gravis, lifestyle changes, and some medications can allow periods without symptoms. Treatment can help relieve signs and symptoms, such as weakness of the muscles in the arms or people.

The goals of treatment must be individualized according to the severity of the disease, the age and sex of the patient, as well as the degree of functional impairment. In some cases, the spontaneous improvement, including remissionsoccur without specific therapy, especially in the early stages of the disease.

The International consensus guidelines for the management of myasthenia gravis recommended medications:

  • cholinesterase inhibitors: These drugs increase communication between nerves and muscles and can help make them stronger.
  • Corticosteroids: The use of prednisone improves more than 75% of patients treated with this drug, which silences the immune system and slows the release of antibodies that could help block nerve receptors.
  • Immunosuppressive drugs: Together with corticosteroids, they can help reduce the response to the immune system.

In more severe cases of the disease or worsening symptoms, other options include plasmapheresiswhich are often used in a crisis, or intravenous immunoglobulin, which involves injecting new antibodies into the bloodstream to alter the immune system’s response.

In the event that myasthenia is due to a tumor in the thymus gland, surgery may be necessary to remove the entire gland (thymectomy). Even if there is no tumor, removal can help relieve symptoms.

As we have already mentioned, the incorporation of Healthy habitssuch as eating a healthy diet, exercising regularly and sleeping the necessary hours can help to face and improve this disease.

Stress control is also key because high levels can worsen the results, both physical and psychological.

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