Myasthenia gravis is an autoimmune disease that causes a breakdown in the normal communication between nerves and muscles. It produces weakness and rapid fatigue of any of the muscles under your voluntary control e.g. muscles of eye, face, throat, neck, arms, hands, legs. 

Myasthenia gravis can affect people of any age group. It is more common in women younger than 40 and in men older than 60.

CAUSES   

The exact cause of Myasthenia gravis is not clear.

• Autoimmune Antibodies – Autoimmune antibodies are immune proteins that mistakenly target and react with a person’s own tissues or organs. One or more autoimmune antibodies may be produced by a person’s immune system when it fails to differentiate between “self” and “non-self.”
• Enlarged thymus gland – the thymus is a specialized organ of the immune system. This gland is the largest and most active during the childhood and pre-adolescent periods. By the early teens, the thymus gland begins to decrease in size and activity, and the tissue of the thymus gland is gradually replaced by fatty tissue. This gland is enlarged in autoimmune disease.
• Infection
• Some medications such as beta-blockers, quinine gluconate, quinidine sulfate, certain anesthetics, and some antibiotics.

SYMPTOMS

• Muscle weakness – it worsens if the affected muscle is frequently used. Because usually, the symptoms improve with rest. 
• Shortness of breath
• Eye muscles – First sign of myasthenia gravis usually involves eye muscles. 

1. Drooping of one or both the eyelids. 
2. Double vision, which may be vertical or horizontal, and improves or resolves when one eye is closed.

• Face and throat muscles – 15% of people affected with myasthenia gravis show the first symptoms involving the face and throat muscles. 

1. Impairment in speaking – depending upon which muscles have been affected, your speech might sound soft or nasal.
2. Difficulty in swallowing – choke easily while eating, drinking. Sometimes, the liquids you are trying to swallow come out of your nose. 
3. Affects the action of chewing – muscles used in chewing might get tired halfway while eating, particularly if you have been eating something hard to chew such as steak.
4. Change in facial expressions – E.g. your smile might look like a snarl because of the weakness of muscles of smiling.

• Neck and limb muscles – Weakness of muscles of neck, arms, hands, legs.

1. Neck – difficulty in holding your head up.
2. Arms, hands – difficulty in holding or lifting any objects. 
3. Legs– Affects your way of walking.

COMPLICATIONS

The complications of myasthenia gravis are treatable. But sometimes it can be life-threatening.

• Myasthenia crisis– a life-threatening condition which can lead to respiratory failure. It occurs when the muscle that controls the breathing becomes too weak, which needs emergency treatment and mechanical assistance with breathing.
• Tumors of the thymus gland – most of these tumors aren’t cancerous.
• Overactive or underactive thyroid gland.
• May develop other autoimmune conditions such as rheumatoid arthritis or lupus.

DIAGNOSIS

• Physical or neurological examination by performing several clinical tests. Your Doctor will check muscle strength and tone, coordination, sense of touch, and look for impairment of eye movements. 
• Edrophonium test – it is usually used to test the weakness of eye muscles.
• Blood test – Acetylcholine receptor antibodies are elevated in most patients with myasthenia gravis.
• Imaging tests – CT and MRI may identify the presence of thymus tumors.
• Pulmonary Function Test – it helps to measure breathing strength. So your Doctor can predict if the presence of respiration may fail and lead to a myasthenia crisis.
• Single fiber electromyography (EMG)

GENERAL MANAGEMENT

• Yoga and mild exercises are helpful in strengthening the muscles and improving blood circulation.
• Do breathing exercises like pranayama.
• Along with yoga, exercises & breathing practices eating habits should also be altered. Simple, nourishing, no stimulating foods, including fresh fruits & lightly cooked vegetables, particularly green vegetables. Asparagus is considered helpful since it contains certain natural steroid-like nutritious elements, which help in strengthening the weakened muscles caused by myasthenia gravis. Make sure the food should have a blend of all necessary vitamins.

HOMEOPATHIC MANAGEMENT

With Homeopathic treatment, most individuals with myasthenia can have significant improvement in their muscle weakness and lead normal or nearly normal lives. Early detection of disease is very helpful in treatment. 

In Patients with a severe form of Myasthenia gravis whose symptoms are not controlled with Conventional treatment, Homeopathy medicines can be given as complementary treatment for better and faster improvement.

Talk to your Homeopathic Doctor if you have difficulty in breathing, seeing, chewing, swallowing, holding up your head, walking, and using your arms or hands.

REFERENCES

1. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Myasthenia-Gravis-Fact-Sheet#:~:text=Myasthenia%20gravis%20is%20a%20chronic,including%20the%20arms%20and%20legs. 
2. https://myasthenia.org/ 
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21. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/myasthenia-gravis 
22. https://www.saintjohnscancer.org/thoracic/conditions/myasthenia-gravis/ 
23. https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/myasthenia-gravis.html 
24. https://www.umms.org/sjmc/health-services/neuromuscular-myasthenia-gravis?__cf_chl_jschl_tk__=pmd_gKuubUHDwDIEsDP2_CHVnQ0Hh7BR8ElA1p9Qs3FUcIc-1634915721-0-gqNtZGzNApCjcnBszQil