Eyelid drooping, double vision, difficulty chewing and swallowing may be a sign of myasthenia gravis.

The prevalence of myasthenia gravis, which means dangerous and serious muscle weakness and prevents the transmission of messages from nerves to muscles and is rare, varies from country to country, but is approximately 20 per 100,000 people. Although there is no prevalence study in our country, it is thought that the prevalence is similar in Turkey. Prof. Dr. İhsan Şükrü Şengün, Faculty Member of Dokuz Eylül University Faculty of Medicine and Chairman of the Turkish Neurology Association Neuromuscular Diseases Working Group, shared important information about myasthenia gravis.

Prof. Dr. İhsan Şükrü Şengün said, “All voluntary striated muscles are carried by electrical impulses coming from the brain and carried to the muscles by peripheral nerves. The impulse coming from the brain to the nerve ending in the muscle causes the release of an excitatory substance called acetylcholine from the nerve ending to the gap called the nerve-muscle junction. This secreted acetylcholine then binds to acetylcholine receptors on the muscle membrane at the nerve-muscle junction, causing these channels to open and sodium ions to enter the muscle cell. The entry of sodium ions into the muscle cell leads to the generation of the electrical potential required for contraction of the muscle cell. In people with an abnormal immune system, the immune system releases antibodies that shut down, alter or destroy these acetylcholine receptors. Then there is a problem in generating the electrical potential required for muscle contraction.”

Eyelid drooping and double vision are common
Prof. Dr. Şengün stated that in the majority of patients, the disease starts with these two complaints and over time, complaints related to other muscles appear. “In some patients, other muscles are not affected and only eye-related complaints remain. In this case, the disease is called ocular myasthenia. In some patients, the functions of bulbar muscles such as chewing, swallowing, speaking and breathing are affected. These patients may have difficulty chewing, especially at dinner, difficulty swallowing, and food may escape into the windpipe while swallowing. In addition to symptoms such as slurred speech and slurring of words during prolonged speech, there are complaints of difficulty in breathing with fatigue. These complaints may occur individually in one patient or as a combination of all of them. Then we talk about bulbar myasthenia. If myasthenia gravis affects the muscles of the arms and legs, generalized muscle weakness occurs with physical work. This type of myasthenia gravis is called generalized myasthenia. Although myasthenia gravis can be in the form of ocular only, bulbar only or generalized myasthenia, it usually appears as a combination of these clinical manifestations,” said Prof. Dr. Şengün.

Patients should consult a neurologist
Prof. Dr. Şengün mentioned “Since myasthenia gravis is a nerve-muscle junction disease, patients with complaints such as droopy eyelids, double vision, swallowing and speech disorders, and weakness during physical activities should consult a neurology judge. The most basic factor in diagnosing myasthenia is the clinical complaints of the patient. The crucial point here is that these complaints occur with fatigue and decrease or disappear with rest. People who use computers intensively in their work are prone to eyelid drooping and double vision because they are constantly looking at the screen. On the other hand, people who have to talk all the time to teach a lesson, such as teachers, are more likely to experience slurred speech in the afternoon. When myasthenia gravis is suspected in a patient who applies to a neurologist with these complaints, fatigue tests as well as ice tests are methods that can be easily applied for definitive diagnosis.”

There are effective treatments
Prof. Dr. İhsan Şükrü Şengün said about the treatment of myasthenia gravis: “First of all, treatment that prevents the breakdown of the chemical called aceticoline secreted into the nerve-muscle junction is started. The main treatment is immunosuppressive treatments to suppress the overactive immune system. However, not all patients may respond fully to these treatments and sometimes intervening infections may disrupt the patient’s prognosis. For patients who do not respond to immunosuppressive treatments, we now have highly effective new treatments that we can easily apply.”

Underlining that some treatments, supplements and substances can worsen myasthenia gravis, Prof. Dr. Şengün stated that botulinum toxin (botox) application, which has been widely used in the fields of aesthetics and weight loss in recent years, can have fatal consequences in myasthenia gravis patients, as well as muscle relaxants and magnesium taken as supplements and some antibiotics can cause myasthenic worsening, so patients should not take a treatment without consulting their doctor. Explaining that myasthenia gravis is now a disease that is easily managed thanks to new diagnostic methods and treatments, Prof. Dr. İhsan Şükrü Şengün said: “Today, the increase in awareness about diseases through social media enables many patients to be diagnosed earlier and start treatment. Especially myasthenia gravis, which used to be a very feared disease because it can impair respiratory function, has now become a more easily managed disease thanks to today’s diagnostic methods and new treatments.”

Pay attention to these warnings
Stating that myasthenia gravis is different from other diseases with some features, Prof. Dr. İhsan Şükrü Şengün explained that especially heat causes worsening of myasthenic complaints. For this reason, it is unfavorable for patients with myasthenia gravis to enter very hot environments such as baths or saunas, Prof. Dr. Şengün said, “In addition, another issue that affects especially female patients is menstrual periods. Myasthenic complaints may worsen during menstrual periods. It is important for patients to be aware of this situation in order to understand that the deterioration in complaints is not a real clinical deterioration or myasthenic crisis. Another issue is that all types of infections worsen myasthenic complaints. For this reason, it is important to avoid infections as much as possible and to be vaccinated for infections that are common in seasonal returns.”

August 2023