Myasthenia gravis-features, treatment and more.


Myasthenia gravis is a condition affecting the neuromuscular junction. It is a relatively rare,also an auto immune disease. It is caused by antibodies blocking acetyl choline receptors. Thus it inhibits its effects.

 It manifests as a generalized muscle weakness, may also affect respiration causing myasthenia crisis.

Clinical features of the disorder-

  • specific muscle weakness, moreover frequently ocular symptoms.
  • ptosis and diplopia (double vision).
  • Generalised weakness may however be seen rarely
  •  fascial muscle weakness
  • Weakness spreads from the ocular and facial and also to truncal and limb muscles.
  • Weakness usually worsens as the day progresses.
  • aggravted by exertion and alleviated by rest.
  • Respiratory muscle weakness develop in up to 40% of patients. This thus may cause respiratory failure.

Classification of myasthenia-

Subtypes –

  1. Early-onset  seen in age group <50 years.
  2. Late-onset- above 50 years
  3. Presence of anti-MUSK antibodies.
  4. Ocular only

Class I: only ocular muscle weakness, possible ptosis.

II: Mild weakness apart from ocular muscless III: Moderate weakness affecting other than ocular muscles.

IV: Severe weakness affecting other than ocular muscles

Medical Management

There are four basic therapies which can be utilised for intervention of myasthenia gravis-

  1. Symptomatic treatment- this can be done with acetylcholinesterase inhibitors.
  2. plasmapheresis and intravenous immunoglobulin.
  3. glucocorticoids and other immunosuppressive drugs.
  4. Surgical treatment: thymectomy

Exercise interventions and patient education-

  • Aim to strengthen large muscle groups.
  • Advise patient to do the exercises at a time when they are not fatigued
  • If on pyridostigmine, exercise 1.5 to 2 hours after dose
  • Only moderate intensity exercises should be performed
  • General aerobic exercise should also be performed.

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