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Myasthenia gravis is a neurological auto-immune ailment manifested by a progressive weakness and fatigue of muscles. It can affect the muscles of the eyes, facial area, shoulders and limbs. In rare instances, the muscles of the chest and diaphragm are affected and may cause life-threatening problems with respiration. Myasthenia gravis affects both men as women, although it is found more commonly in men. It can also occur in infants and children.
The disease usually reaches its peak of severity in the first three years of symptoms. After this time, the chance for a positive stabilization and remission of the disease increases. Management of the disease depends upon the age of the patient, the type of myasthenia gravis and the severity of symptoms.
With this disease, the body produces antibodies against parts of itself, in this case the muscles. The antibodies attack nerve receptors which cause a lack of nerve and muscle communication, impairing the ability of muscles to contract. Repetitive tasks cause extreme muscle fatigue and weakness. This weakness is not generalized over the body but rather within those muscle group areas involved. Common signs may include drooping eyelids, a blank facial expression, facial paralysis, arm and leg weakness, drooping head, poor posture and double vision. In some cases, there is difficulty with chewing or swallowing.
When there is difficulty with swallowing (dysphagia), patients may also have difficulty with chewing. This may progress to a stage where neither is possible (due to coughing and choking)and food must enter the body by nasogastric feeding, in which a narrow tube is inserted through the nostril into the stomach. For those whose eating problems are less serious, a soft or pureed diet may be recommended to reduce the coughing and choking that is present when attempting to swallow. People who suffer with this type of myasthenia gravis are encouraged to eat smaller meals containing moist, more liquid foods that require less chewing and swallowing motions, thus taking stress off the muscles that perform these tasks. Care must also be taken to keep the nutritional content high with those who have these problems since the discomfort associated with the ailment may make a patient lose interest in eating and lose weight rapidly, lowering defenses against other ailments.
Another form of this ailment is ocular myasthenia gravis. This type affects the eye muscles and is characterized by drooping eyelids, involuntary tearing of the eyes, poor eye reflexes and double vision.
In rare cases, myasythenia gravis symptoms affect the respiratory muscles and diaphragm and can cause difficulty or inability breathing. In these instances, respiration might only be accomplished through artificial devices. This is extremely serious and can be life-threatening.
Although no definite cause of myasthenia gravis is known, it is known that factors such as temperature, stress, overexertion and repetitive activity can aggravate the condition. Certain medicines such as anesthetics, muscle relaxers and some antibiotics can also trigger episodes. Individuals with low potassium levels and thyroid imbalances are at higher risk for having this ailment. It has been noted that the attacks seem to increase in severity late in the evening and that a cooler temperature seems to have a positive effect on symptoms.
Although no cure exists at present, there are several treatments that can manage the disease in most cases. A common treatment involves prescribing corticosteroids for moderate to severe symptoms. Pyridostigmine bromide is sometimes used in combination with these drugs to reduce symptoms.
The drug azathioprine has been known to restore muscle control in some patients although treatments may not show any positive effects for more than two years. Cyclosporine usually works within two months to reduce discomfort but has several serious side-effects and cannot be used to treat patients with certain health problems.
Surgical removal of the thymus gland, which controls the immune system, is sometimes used to eliminate or reduce the production of the attacking antibodies. This procedure--thymectomy--is also used when there is a thymic tumor, as is often the case with myasthenia gravis sufferers. Any abnormality of the thymus can cause the disease. This treatment has been very successful for sending this disease into remission although recurrence has been noted.
Plasmapheresis is another fairly common procedure for myasthenia patients in which blood plasma (which contains the attacking antibodies) is removed and replaced with donated plasma and other fluids.
Although not all is known concerning this ailment, procedures do exist to make management of the disease possible, with the patient able to live a normal life.
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