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Treatment of Myasthenia gravis

Homeopathic Treatment of Myasthenia Gravis

Myasthenia gravis is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. Myasthenia gravis causes weakness in the muscles under your control. It happens because of a problem in communication between your nerves and muscles.

Though myasthenia gravis can affect people of any age, it's more common in women younger than 40 and in men older than 60.

Causes of Myasthenia Gravis:

It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions.

Antibodies: Nerves communicate with your muscles by releasing chemicals (neurotransmitters) that fit precisely into receptor sites on the muscle cells at the nerve-muscular junction. In myasthenia gravis, your immune system produces antibodies that block or destroy many of your muscles' receptor sites for a neurotransmitter called acetylcholine. With fewer receptor sites available, your muscles receive fewer nerve signals, resulting in weakness.

Antibodies may also block the function of a protein called a muscle-specific receptor tyrosine kinase. This protein is involved in forming the nerve-muscular junction. When antibodies block the function of this protein, it may lead to myasthenia gravis.

Thymus Gland: Thymus gland, a part of your immune system situated in the upper chest beneath your breastbone, may trigger or maintain the production of the antibodies that block acetylcholine. Large in infancy, the thymus is small in healthy adults. In some adults with myasthenia gravis, however, the thymus is abnormally large. Some people with myasthenia gravis also have tumors of the thymus (thymomas). Usually, thymomas aren't cancerous.

Other causes:

1. Some people may have myasthenia gravis that isn't caused by antibodies blocking acetylcholine or the muscle-specific receptor tyrosine kinase. This type of myasthenia gravis is called antibody-negative myasthenia gravis. Antibodies against another protein, called lipoprotein-related protein 4, may play a part in the development of this condition.

2. Genetic factors also may be associated with myasthenia gravis.

3. Rarely, mothers with myasthenia gravis have children who are born with myasthenia gravis (neonatal myasthenia gravis). If treated promptly, children generally recover within two months after birth.

4. Some children are born with a rare, hereditary form of myasthenia, called congenital myasthenic syndrome.

 

Symptoms of Myasthenia Gravis:

Muscle weakness caused by myasthenia gravis worsens as the affected muscle is used repeatedly. Because symptoms usually improve with rest, your muscle weakness may come and go.

Although myasthenia gravis can affect any of the muscles that you control voluntarily, certain muscle groups are more commonly affected than others.

Eye muscles:

In more than half the people who develop myasthenia gravis, their first signs and symptoms involve eye problems, such as:

  • Drooping of one or both eyelids (ptosis).
  • Double vision (diplopia), which may be horizontal or vertical, and improves or resolves when one eye is closed.

Face and throat muscles:

In about 15 percent of people with myasthenia gravis, the first symptoms involve face and throat muscles, which can cause:

  • Altered speaking. Your speech may sound very soft or nasal, depending upon which muscles have been affected.
  • Difficulty swallowing. You may choke very easily, which makes it difficult to eat, drink or take pills. In some cases, liquids you're trying to swallow may come out your nose.
  • Problems chewing. The muscles used for chewing may wear out halfway through a meal, particularly if you've been eating something hard to chew, such as steak.
  • Limited facial expressions. Your family members may comment that you've "lost your smile" if the muscles that control your facial expressions have been affected.

Neck and limb muscles:

Myasthenia gravis can cause weakness in your neck, arms and legs, but this usually happens along with muscle weakness in other parts of your body, such as your eyes, face or throat.

The disorder usually affects arms more often than legs. However, if it affects your legs, you may waddle when you walk. If your neck is weak, it may be hard to hold up your head.

Diagnosis of Myasthenia Gravis:

To diagnose your condition, your doctor will review your symptoms and your medical history and conduct a physical examination. Your doctor may conduct several tests, including:

Neurological examination: Neurological testing is done for:

  • Reflexes
  • Muscle strength
  • Muscle tone
  • Senses of touch and sight
  • Coordination
  • Balance

The key sign that points to the possibility of myasthenia gravis is muscle weakness that improves with rest.

Tests to help confirm the diagnosis may include:

Edrophonium test:

Injection of the chemical edrophonium chloride (Tensilon) may result in a sudden, although temporary, improvement in your muscle strength. This is an indication that you may have myasthenia gravis. Edrophonium chloride blocks an enzyme that breaks down acetylcholine, the chemical that transmits signals from your nerve endings to your muscle receptor sites.

Ice pack test:

If you have a droopy eyelid, your doctor may conduct an ice pack test. In this test, a doctor places a bag filled with ice on your eyelid. After two minutes, your doctor removes the bag and analyzes your droopy eyelid for signs of improvement. Doctors may conduct this test instead of the edrophonium test.

Blood analysis:

A blood test may reveal the presence of abnormal antibodies that disrupt the receptor sites where nerve impulses signal your muscles to move.

Repetitive nerve stimulation:

In this nerve conduction study, doctors attach electrodes to your skin over the muscles to be tested. Doctors send small pulses of electricity through the electrodes to measure the nerve's ability to send a signal to your muscle.

To diagnose myasthenia gravis, doctors will test the nerve many times to see if its ability to send signals worsens with fatigue.

Single-fiber electromyography (EMG):

Electromyography (EMG) measures the electrical activity traveling between your brain and your muscle. It involves inserting a fine wire electrode through your skin and into a muscle.

Imaging scans:

Your doctor may order a CT scan or an MRI to check if there's a tumor or other abnormality in your thymus.

Pulmonary Function Tests:

Your doctor may perform pulmonary function tests to evaluate whether your condition is affecting your breathing.

Treatment of Myasthenia Gravis:

Homeopathic Treatment for Myasthenia gravis:

Homeopathy has effective treatment for Myasthenia Gravis. Properly selected homeopathic remedy gives a long term relief from all symptoms of the patient. Homeopathy has shown its efficacy in reducing the frequency of relapses and improving the power and tone of muscles. The role of homeopathy is more as long term control, rather than for acute crisis control. Homeopathy with its constitutional approach works at deeper level and brings deviations of immune system back to normalcy and in consequence minimizes the need of exogenous neurotransmitters or steroids as prescribed by conventional treatment. Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc.

Allopathic Treatment of Myasthenia Gravis:

  • Cholinesterase inhibitors: Medications such as pyridostigmine (Mestinon) enhance communication between nerves and muscles. These medications don't cure the underlying condition, but they may improve muscle contraction and muscle strength.
  • Corticosteroids: Corticosteroids such as prednisone inhibit the immune system, limiting antibody production.

Prolonged use of corticosteroids, however, can lead to serious side effects, such as bone thinning, weight gain, diabetes and increased risk of some infections.

  • Immunosuppressants: Your doctor may also prescribe other medications that alter your immune system, such as azathioprine (Imuran), mycophenolate mofetil (CellCept), cyclosporine (Sandimmune, Neoral) or tacrolimus (Prograf).

Therapy of Myasthenia Gravis:

  • Plasmapheresis (plaz-muh-fuh-REE-sis): This procedure uses a filtering process similar to dialysis. Your blood is routed through a machine that removes the antibodies that block transmission of signals from your nerve endings to your muscles' receptor sites. However, the beneficial effects usually last only a few weeks.
  • Intravenous immunoglobulin (IVIg): This therapy provides your body with normal antibodies, which alters your immune system response.IVIg has a lower risk of side effects than do plasmapheresis and immune-suppressing therapy. However, it may take about a week to start working, and the benefits usually last no more than three to six weeks.

Surgery of Myasthenia Gravis:

About 15 percent of the people with myasthenia gravis have a tumor in their thymus gland, a gland under the breastbone that is involved with the immune system. If you have a tumor, called a thymoma, doctors will conduct surgery to remove your thymus gland (thymectomy).

If you don't have a tumor in the thymus gland, surgery to remove the thymus gland may improve your myasthenia gravis symptoms. It may eliminate your symptoms, and you may be able to stop taking medications for your condition. However, you may not notice the benefits of a thymectomy for several years, if at all.