VIDA LAB by Rowan Albritton
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neurological

Myasthenia Gravis

A chronic autoimmune disease causing muscle weakness that worsens with activity and improves with rest.

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In this report
  1. Overview
  2. Symptoms
  3. Diagnosis
  4. Treatments
  5. Medical Resources
  6. Your Care Plan

Overview

Myasthenia gravis (MG) is a chronic autoimmune disease in which the immune system produces antibodies that block or destroy muscle receptor sites, disrupting communication between nerves and muscles. This causes weakness in voluntary muscles that worsens with activity and improves with rest.

MG affects about 20 in 100,000 people and can occur at any age. It is more common in women under 40 and men over 60. The disease most commonly affects the eye muscles (causing drooping eyelids and double vision), facial muscles, and muscles of the arms and legs. In severe cases, it can affect breathing and swallowing — a myasthenic crisis is a medical emergency.

The thymus gland is often abnormal in MG, and about 10–15% of patients have a thymoma (thymus tumor). While there is no cure, modern treatments allow most people to manage symptoms effectively and lead full lives.

Symptoms

  • Drooping eyelids (ptosis) — often the first symptom
  • Double vision (diplopia)
  • Difficulty swallowing or chewing
  • Slurred or nasal speech
  • Weakness in arms and legs
  • Difficulty holding up the head
  • Fatigue that worsens with activity and improves with rest
  • Difficulty breathing in severe cases (myasthenic crisis)
  • Weakness that varies throughout the day, typically worse in the evening

Diagnosis

  1. Blood tests — anti-acetylcholine receptor (AChR) antibodies (positive in 85% of cases); anti-MuSK antibodies in AChR-negative cases
  2. Repetitive nerve stimulation test — shows characteristic decrement in muscle response
  3. Single-fiber EMG — the most sensitive test for MG
  4. Edrophonium (Tensilon) test — a medication that temporarily improves strength; less commonly used now
  5. CT or MRI of the chest — to evaluate the thymus gland for thymoma
  6. Pulmonary function tests — to assess respiratory muscle strength

A neurologist makes the diagnosis.

Treatments

  • Acetylcholinesterase inhibitors — pyridostigmine (Mestinon); improves communication between nerves and muscles
  • Immunosuppressive medications — corticosteroids, azathioprine, mycophenolate, methotrexate, or cyclosporine
  • Thymectomy — surgical removal of the thymus gland; recommended for patients with thymoma and may improve symptoms in some patients without thymoma
  • Plasma exchange (plasmapheresis) — for severe exacerbations or myasthenic crisis
  • Intravenous immunoglobulin (IVIG) — for acute exacerbations
  • Biologic agents — eculizumab or ravulizumab for refractory cases
  • Lifestyle — rest, avoiding heat and stress, managing other illnesses promptly
  • Monitoring — regular assessment of respiratory and bulbar function

Your Care Plan

A step-by-step guide to navigating your condition, from finding the right doctors to advocating for the care you deserve.

Step 1: Doctors to See

Start with: Your primary care physician for initial evaluation.

Then seek: A neurologist who specializes in neuromuscular disorders.

Build your team:

  • Neurologist (neuromuscular specialist) — for disease management
  • Thoracic surgeon — if thymectomy is recommended
  • Pulmonologist — for respiratory monitoring
  • Speech therapist — for swallowing and speech difficulties
  • Ophthalmologist — for vision management
  • Physical and occupational therapist — for strength and function

Step 2: Advocate for Yourself

If you have drooping eyelids, double vision, or muscle weakness that worsens with activity and improves with rest, ask about myasthenia gravis testing. MG is often misdiagnosed as fatigue, eye strain, or other neurological conditions. If your symptoms fluctuate through the day, mention this specifically — it's a hallmark of MG. If you have breathing or swallowing difficulty, seek emergency care — this could be a myasthenic crisis.

Step 3: Your Action Plan

  1. See a neurologist for evaluation of muscle weakness.
  2. Get blood tests for AChR and anti-MuSK antibodies.
  3. Get an EMG and repetitive nerve stimulation test.
  4. Get a chest CT to evaluate the thymus gland.
  5. Start pyridostigmine as prescribed for symptom relief.
  6. Discuss immunosuppressive treatment for long-term control.
  7. If thymoma is found, discuss thymectomy with a thoracic surgeon.
  8. Know the signs of myasthenic crisis — breathing difficulty requires emergency care.

Important: This report is educational information, not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.

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