Myasthenia Gravis

Overview

MG typically affects the muscles of the eyes, face, throat, and limbs. Weakness classically worsens with repeated use and improves with rest. Ocular MG is limited to eye muscles, while generalized MG affects broader muscle groups including those involved in breathing and swallowing. Early diagnosis and treatment improve quality of life. Dr. Jitendra Prasad Yadav provides clinical assessment and management coordination for MG patients in Kathmandu.

Symptoms

• Ptosis — drooping of one or both eyelids, often worse later in the day
• Double vision (diplopia) due to eye muscle weakness
• Facial weakness — difficulty smiling, chewing, or holding the head up
• Speech that becomes nasal or slurred with prolonged talking (dysarthria)
• Difficulty swallowing or choking on liquids (dysphagia)
• Weakness of arms, legs, or neck that worsens with repetitive use
• Respiratory difficulty in severe cases (myasthenic crisis) — a medical emergency

Causes

• Autoimmune — antibodies against acetylcholine receptors (AChR) at the neuromuscular junction
• Some patients have antibodies against muscle-specific kinase (MuSK) or other targets
• Thymic abnormalities (thymoma or thymic hyperplasia) in approximately 10–15% of patients
• Rarely, drug-induced or paraneoplastic

Risk factors

• Female sex (younger onset) and male sex (older onset)
• Thymic abnormalities (thymoma)
• Other autoimmune conditions (thyroid disease, lupus)
• Family history of autoimmune disease

Diagnosis

Clinical history of fatigable weakness, ice pack test (improvement of ptosis with cooling), repetitive nerve stimulation showing decremental response, and single-fiber EMG. Blood tests for AChR or MuSK antibodies and CT chest to evaluate the thymus. Dr. Jitendra assesses clinical signs and coordinates appropriate investigations.

Treatment & management

Acetylcholinesterase inhibitors (pyridostigmine) for symptomatic relief, immunosuppressive therapy (corticosteroids, azathioprine, mycophenolate) for long-term control, thymectomy when thymoma is present or in generalized MG, and plasma exchange or IVIG for acute exacerbations or myasthenic crisis. Ongoing monitoring with a neurologist is essential.

Management is individualized and discussed with benefits, limitations, and follow-up.

Prevention & self-care

No proven prevention. Avoiding medications that may worsen MG (certain antibiotics, beta-blockers, magnesium) and prompt reporting of worsening symptoms are important. Thymectomy in selected patients may reduce disease burden.

When to seek medical attention

• Worsening difficulty breathing or shortness of breath
• Inability to swallow or frequent choking
• Severe drooping of eyelids or double vision affecting daily function
• Sudden worsening of previously stable weakness
• Known MG patient with respiratory distress — seek emergency care immediately

Frequently asked questions