Myasthenia gravis is a disease, which is paid much attention to by specialists practically of all fields of medical science. Doctors face difficulties at all the stages of communication with the patients suffering of myasthenia gravis. It is difficult for them to make a correct diagnosis, to carry out differential diagnostics with similar pathological conditions, to choose an optimum strategy and tactics of treatment, to solve the problems of social and psychological adaptation of the patients. Moreover, the doctors have to answer the questions of pregnancy and childbirth possibility of the patients. They have to solve a set of other problems occurring with the given categories of the patients, who need a supervision and communication with the doctor for long years of their illness. Myasthenia gravis is a disease, which is characterized by violations of neuromuscular transmission, weakness and pathological fatigue of skeletal cross-striped muscles (MedlinePlus). Myasthenia gravis is a chronic serious disease, which is progressing, quite often resulting in disability, so it demands a careful supervision and treatment.
The Anatomy of Human Muscles
Pathological muscular weakness is characterized by motor violations, selectivity of muscles’ damage, discrepancy of muscles’ dysfunction, and zones of muscle innervations. Muscles are human’s body organs, which consist of a muscular tissue having cross-striped structure and capable to be contracted under the influence of nervous impulses, which are sent to a brain (MedlinePlus). Owing to muscular contractions, people are able to carry out various actions: they can move, speak, breathe, make more difficult movements, and train. Muscles of a person make about 40% of all body weight (Bird). Their main function consists of making a movement owes to their ability to contract and relax in a coordinated manner.
The nervous system in its turn provides a link between a head and a spinal cord with muscles. People’s appearance as well as correct functioning of separate systems, organs and body as a whole, depends on correct and harmonious work of a chain “a brain — a nervous system — muscles” (Bird).
Making Diagnosis of Myasthenia Gravis
Myasthenia gravis’ symptoms often remain not distinguished. Unfortunately, myasthenia is most often diagnosed when the disease has already proceeded for some years and passed into the advanced stage. For this reason, any inexplicable fatigue and muscle slackness, which are increasing strongly at the repeating movements, need to be regarded as a possible symptom of myasthenia gravis till this diagnosis is completely disproved. Initial symptoms of the disease are “attenuation of a voice” during the conversation, difficulties in chewing of firm food up to refusal of it, swallowing violation, fast fatigue during hair combing, going upstairs, climbing a ladder, usual walking, emergence of a shuffling walk, falling of eyelids (Bird). Oculomotor, mimic, chewing muscles as well as muscles of a throat and gorge are affected most often. The local form of myasthenia gravis is characterized by manifestation of muscular weakness of certain muscle groups. Muscles of a trunk or extremities are involved in the process during a generalized form of the disease.
Such groups of muscles are more often affected as cross–striped: oculomotor (60-90%); face (75%); chewing (30%); bulbarny (30%); muscles of hand extremities (77%), feet (55%); muscles of a neck and trunk (30%) (Mayo Clinic).
The diagnosis “myasthenia gravis” is, as a rule, largely delayed, despite simplicity of clinical manifestations of this disease and general availability of the diagnostic tests confirming this diagnosis (Mayo Clinic). The reason is a relative rarity of this illness. Numerous neurologic phenomena, caused by violations of the most various structures of the neuromotor system, can hide behind the myasthenia gravis. An important factor is the earliest identification of a syndrome of pathological muscular weakness and a prescription of the pathogenetic therapy, promoting normalization of a neuromuscular transmission, which gives a chance to the patients with myasthenia gravis to keep their working capacity for a long time.
The acquired myasthenia gravis is connected with the formation of antibodies against the acetylcholine receptors of a postsynaptic membrane of a neuromuscular synapse (Bird). An active role is played by a thymus gland in the pathogenesis of the autoimmune reaction. A congenital myasthenia gravis is a much rarer disease caused by the genetic-determined defect of the neuromuscular synapses (Bird). Neonatal myasthenia gravis is a passing condition, which is observed at the babies who were born from the mothers suffering from myasthenia gravis (MedlinePlus). This tendency is caused by the transition of maternal antibodies to acetylcholine receptors through a placenta.
Not only hyperplasia but also thymoma are often diagnosed, then the disease becomes malignant. Autoantibodies are created in a thymus gland or other organs of immunity. They contact with protein of acetylcholine receptors, cause degradation and destroy the membrane gradually. Because of that, the synoptic crack extends, the reliability factor decreases, and therefore, the possibility of carrying out a partial or full block of neuromuscular transfer decreases as acetylcholine arrives. However, it does not bind only with a small amount of receptors.
The myasthenia gravis is diagnosed on the basis of complaints of fatigue, strengthening of the available frustration in the evening and during a physical activity. A proserin test is essential: a sharp reduction of symptoms in 30–60 minutes after the injection of 1-2 ml of 0,05% proserin solution hypodermically (Bird). The change of electroexcitability of muscles is also typical: a fast exhaustion of their contraction during repeated irritations with the current and a restoration of excitability after the rest. A valuable method in myasthenia gravis diagnostics is an electromyographic research. During the electromyography stimulation a normal total potential of muscle activities is registered. Its amplitude decreases at rhythmic stimulation with the frequency 3–5 and 50 impulses in 1 second (Bird).
The differential diagnosis is carried out with stem encephalitis, a brain trunk tumor, basal meningitis, and an ocular form of myopathy, polymyositis and violations of brain blood circulation.
The term “myasthenic crisis” is meant as a weakness attack, appeared suddenly and concentrated in pharyngeal and respiratory muscles (MedlinePlus). It leads to clear breath violations. The breath becomes whistling and it speeds up. The pulse also becomes frequent and salivation is also evident. It is important to note that paralysis, which, respiratory muscles experience in its heavy form, is a direct threat for the patient’s life (Bird). Considering a chronic and progressing character of myasthenia gravis and its heavy manifestations, the disability cases take place rather often. Respectively, it is necessary not only a careful supervision, but also a corresponding treatment of the patient at the emergence of the first disturbing symptoms of myasthenia gravis.
Myasthenia gravis is widespread among young people – from 20 to 40 years old (Bird). Women are much more often subjected to the disease. The official ratio is 3:1, but it is very probable that the first figure is higher (Bird). According to the statistics given on the site of the Mayo Clinic, 10 people from each 100 000 population suffer this disease. More than 80% of the patients reach remission (Mayo Clinic).
Myasthenia Gravis Treatment
The main emphasis of myasthenia gravis treatment consists in application the anticholinesterase preparations. The dosages determined by the doctor have to be observed exactly, otherwise, overdose with the development of cholinergic intoxication (cholinergic crisis) can be formed (Bird). That is expressed in twitching, spasms, narrowing of the pupils and pulse slowing down as well as in spasms and belly-aches, in a plentiful salivation. The treatment, with the application of the anticholinesterase preparations, is carried out for years with necessary changing of a dosage depending on the severity of the disease. For strengthening of these preparations activity potassium salts are also used, the potassium delay in the body is provided with a purposeful therapy. The heavy clinical course of the disease assumes the use of cytostatic drugs and hormonal therapy. Considerable efficiency is noted at “pulse therapy” where high doses of hormonal preparations with their subsequent gradual decrease are applied (Bird). Immunosuppressants are also applied. In case of thymoma detection the patient needs surgery. Hard cases of the myasthenic crisis provide the need for carrying out an artificial ventilation of lungs and a plasmapheresis in the conditions of resuscitation departments. In addition the injections of immunoglobulins, ephedrine and proserin are required.
Non-Traditional Treatment of Myasthenia Gravis
Along with medicine and other classical methods of treatment, there is also a non-traditional treatment of myasthenia gravis, which is considered to be quite effective (MedlinePlus). Myasthenia treatment with exclusively non-traditional remedies will not lead to an absolute healing. Therefore, the greatest effect is observed when carrying out treatment in the integrated way.
The most popular and effective recipes are based on the regular use of garlic, onions, citruses, raisins, dried apricots, bananas, oats and honey. Many of these products are rich with potassium, which is needed according to the special clinical treatment of this illness. Potassium is necessary for normal work of skeletal muscles and for improvement of muscular contractions in case of myasthenia and muscular dystrophy.
Thus, the active autoimmune process, damaging a postsynaptic membrane, is the cornerstone of myasthenia gravis. Myasthenia gravis is a serious disease, which begins gradually in many cases and usually has a progressing character. It demands early diagnostics and an active tactics in immunnosuppressant therapy from the doctors (thymectomy, corticosteroids, cytostatics, a plasma exchange, immunoglobulins). The best non-traditional remedy in fight against myasthenia gravis is its preliminary prevention. The main points in good health are healthy lifestyle, regular physical activities, and healthy nutrition, absence of nervous stresses and started chronic diseases and sufficient rest. Regular visits to the doctor, especially in cases of any suspicions or complaints to the health, are also necessary.