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Thursday, June 20, 2013
- What are the most common symptoms of Myasthenia Gravis?
- What are typical problems with muscle weakness and Myasthenia Gravis?
- Does Myasthenia Gravis cause cramping, tremors, spasms, seizures, one-sided weakness or a burning/hot feeling?
- What are the symptoms of Ocular Myasthenia Gravis?
- What are the symptoms of a Myasthenia Gravis crisis?
The major symptom of Myasthenia Gravis is muscle weakness, which gets worse with activity. Often, patients feel well in the morning, but as the day goes on, they become weaker. The muscle weakness usually causes symptoms of double vision and drooping eyelids (ptosis).
Muscle weakness typically worsens as the muscle is used. Most patients feel that rest improves the muscle strength, but this is not always the case. Sensation is normal. Weakness may affect the neck, arms, legs, and the muscles used for breathing, swallowing, or talking. If patients have severe weakness that does not respond to treatment, they may develop a constant state of weakness. Muscle shrinking (atrophy) is not part of Myasthenia Gravis, but some patients with severe weakness for many years may have some atrophy (muscle wasting). Occasionally, patients may only experience symptoms in the leg, but a doctor may perform tests to find out if there is weakness in other areas of the body. It is unlikely for MG to be present only in one area, such as a leg, and not be present elsewhere in the body. Myasthenia Gravis does not produce loss of coordination, except as related to weakness. Myasthenia Gravis can produce isolated finger weakness.
Myasthenia Gravis does not cause true tremors. Some patients with arm weakness may have a sensation of tremor when they strain to perform activity. Some medications used to treat MG, like Prednisone and Cyclosporine, may cause tremors. The weakness of muscles can make a Myasthenic have difficulty with movement and feel uncoordinated. MG does not cause seizures, cramping, weakness only on one side of the body, burning of the tongue or bottom of feet, hot flashes (these could be related to Prednisone therapy), numbness or tingling. Mestinon frequently causes muscle spasms and twitching of the muscles. Mestinon may produce, or worsen, cramps
Symptoms of Ocular Myasthenia Gravis are drooping eyelids, double vision, visual confusion or unsteadiness. 95% of patients with Myasthenia Gravis will have drooping eyelids or double vision at some time in their illness. About 80% of patients with Ocular MG will progress to experience other symptoms. Only 10% of patients with Ocular Myasthenia Gravis will report that the symptoms and disease has remained restricted to the eye muscles. Visual problems can be helped in several ways. Eye patches eliminate double vision and lifting devices (ptosis tape or crutches) elevate the eyelids. Often Mestinon helps the strength of the eye muscles and improves drooping lids and double vision. Prednisone suppresses the immune system and often improves these symptoms, but one must be aware of the complications of this medication. About half of patients with Ocular MG do not have antibodies to the acetylcholine receptor, which is one of the markers that doctors use to diagnose MG.
A Myasthenia Gravis crisis involves several breathing difficulties (shortness of breath) due to muscle weakness. A crisis is defined as being unable to breathe to the point that one needs a ventilator, which is a breathing machine. This usually occurs over days to weeks, not suddenly, as the term suggests. The crisis is often induced by another medical condition, such as an infection.
In a crisis, the most dangerous signs are breathing and throat muscle weakness. The shortness of breath may become severe enough to require hospitalization for breathing support (ventilator), as well as treatment for the underlying infection. If the problem is not identified and treated correctly, it could lead to death. Problems with swallowing (choking and coughing frequently while eating) from throat muscle problems may lead to aspiration of food into the lungs, which will lead to pneumonia. It is important for MG patients to notify their neurologists with symptoms of shortness of breath.
Last Reviewed: Dec 29, 2003
Henry J Kaminski, MD
Formerly, Professor of Neurology
School of Medicine
Case Western Reserve University