Neurologists at the leading private clinic Herzliya Medical Center in Israel specialize in the treatment of myasthenia gravis in children and adults. Specialists’ neurological center develop protocols in order to accurately diagnosis of congenital and acquired forms of the disease. Highly effective methods of treatment and rehabilitation guarantee a favorable prognosis.
What is Myasthenia Gravis?
Myasthenia Gravis (MG) – a serious disease of the peripheral nervous system, which is based on an autoimmune process, which selectively affects neuromuscular synapses (connections). A defect in the transmission of impulses from nerve endings in the muscle fibers resulting in the development of skeletal muscle weakness.
Scientists have not yet been able to determine the exact cause of the development of autoimmune diseases, in which the immune system of the human body begins to produce antibodies against its own healthy cells. Researchers believe the thymus could be one of the factors responsible for the condition by producing antibodies to block acetylcholine (a neurotransmitter). Furthermore, antibodies may block a receptor protein called tyrosine kinase.
Myasthenia gravis can exacerbate by a viral infection, severe stress and certain types of medication. The autoimmune form is not contagious and is not inherited. The disease is most common in young women (under 40 years of age), but can develop at any age, in addition, it affects men over 60 years of age.
Types of Myasthenia Gravis
The following types of myasthenia gravis exist:
- Congenital myasthenia – not an autoimmune disease but a defect in the genes which result in abnormal proteins, inherited as an autosomal recessive disease
- Transient neonatal myasthenia gravis – relatively rare form of myasthenia gravis may develop in a child immediately after birth. The reason for this is the mother’s antibodies, suffering from a disease transmitted through the placenta. It is necessary to distinguish the neonatal form of another type of myasthenia gravis associated with a genetic mutation COLQ and inherited
- Juvenile myasthenia gravis – Develops in childhood and adolescence, usually, girls occur in approximately 10% of MG cases
- Generalized myasthenia gravis – the most common form of the disease. The most characteristic occurrence of the disease in women aged 20-30 and men aged 50-60 years
- Ocular myasthenia gravis – around 10-15% of people only experience problems with the muscles that control eye movement
Myasthenia Gravis Symptoms
The most common symptoms of myasthenia gravis include:
- Visual problems – ptosis (drooping of the upper eyelid), diplopia (double vision)
- The weakness of the muscles of the upper and lower extremities. Patients often describe the following symptoms of myasthenia gravis: Difficulties in the transition from a sitting to a standing position, as well as climbing the stairs, the inability to raise his hands above his head, reduced tolerance to previously routine physical activity
- Violations of speech and swallowing
- Extreme weakness of the neck muscles
- Facial expressions (mask-like face), altered speech (nasal-sounding), difficulty chewing and swallowing
The symptoms of myasthenia gravis usually worsen when muscles are overly used during the day, while at rest symptoms improve. However, over time, the progressive autoimmune disease gradually leads to significant functional impairment (including secondary muscle atrophy) and can cause severe disability. Myasthenic crisis, for example, occurs in severe, progressive forms of MG, where the muscles that control breathing are affected – this is a life-threatening situation and requires immediate attention.
Myasthenia Gravis Diagnosis at HMC
Diagnosis of myasthenia gravis is performed by the best neurologists’ and includes:
- A detailed neurological examination to ascertain the characteristic symptoms
- Ice pack test – assess the improvement of droopy eyelids
- Edrophonium (Tensilon) test – injection of the drug blocks the enzyme that breaks down acetylcholine – a chemical by which transmits pulses in neuromuscular synapses. The introduction of this drug briefly restores muscle strength, which is an important diagnostic criterion for the disease
- Blood tests for the presence of abnormal antibodies
- Genetic studies in order to eliminate hereditary forms of myasthenia gravis
- Study conduction velocity in nerve fibers and neuromuscular synapses (electromyography)
- Imaging – CT and MRI of the thymus
Myasthenia Gravis Treatment
Among the main treatments for myasthenia gravis in Israel:
- Anticholinesterase drugs – neostigmine (Prostigmin) or edrophonium (Tensilon), a group of drugs that inhibit cholinesterase activity, enhancing smooth muscle of various organs
- Drugs that suppress the activity of the autoimmune process, including steroids
- Removal of the thymus gland (thymectomy). It is noted that after this procedure, patients’ antibody titer is significantly reduced, which increases the likelihood of prolonged remission
Myasthenia Gravis Prognosis
Myasthenia gravis tends to progress in severity over a period of 3 years, following, which a patient either stabilizes or improves. Patients with ocular myasthenia gravis whose symptoms have shown no further progression tend to have a better prognosis than those with generalized myasthenia gravis. Timely referral to a specialist and early diagnosis can prevent the progression of muscle weakness, as well as the development of serious complications of myasthenia gravis. Modern methods of treatment of exacerbation symptoms contribute to the achievement of stable remission. Favorable prognosis of myasthenia is noted in over 80% of cases. Patients at Herzliya Medical Center have the opportunity to complete a full course of rehabilitation in order to maximize the recovery of motor function.