Myasthenia Gravis Symptoms: Drooping Eyelids, Double Vision and Muscle Weakness

What it involves

The MedlinePlus encyclopedia explains that myasthenia gravis is a neuromuscular disorder and an autoimmune one: the body makes antibodies that block muscle cells from receiving messages from nerve cells. It causes weakness of the voluntary muscles that worsens with activity and improves with rest.

Who this is for

• Adults with a drooping eyelid or double vision that comes and goes.
• Patients whose chewing, talking or swallowing tires out as a meal or conversation goes on.
• People with weakness of the arms, legs or neck that is worse late in the day.
• Anyone with an autoimmune condition, such as thyroid disease or rheumatoid arthritis, and new weakness.

What to expect

• Questions about when symptoms start, what makes them worse and which medicines you take
• A nervous system exam that tests eye movements, muscle strength, reflexes and sensation
• Blood work, which the practice offers, for general causes of weakness and fatigue
• A referral to a neurologist for antibody tests, nerve and muscle studies and chest imaging

Go to the ER for breathing or swallowing trouble

The MedlinePlus encyclopedia says to go to the emergency room or call 911 if you have breathing difficulty or swallowing problems. It describes a myasthenic crisis, an attack of weakness of the breathing muscles that can occur without warning, including when too much or too little medicine is taken. It can need a hospital stay and breathing assistance. Sudden facial droop, slurred speech or one-sided weakness can also mean a stroke, which the stroke warning signs guide explains.

How the weakness behaves

What marks myasthenia gravis is that the weakness fluctuates. The encyclopedia says it gets worse with exercise and better with rest, and the eye muscles are usually affected first. Reflexes and feeling are normal. Symptoms include trouble maintaining a steady gaze, facial weakness, a changing voice, chewing or swallowing trouble that causes gagging or choking, difficulty climbing stairs or rising from a chair, and a drooping head. Weakness that does not fluctuate is described in the muscle weakness guide.

Why it happens and who gets it

MedlinePlus says antibodies block the signal from nerve to muscle, and that the condition is sometimes linked to tumors of the thymus, an organ of the immune system. It can affect people at any age and is most common in young women and older men. It also raises the chance of other autoimmune disorders, including thyroid overactivity, rheumatoid arthritis and lupus. The rheumatoid arthritis guide and the thyroid blood tests guide describe two related checks.

How it is diagnosed

Your provider does a detailed nervous system exam. The encyclopedia lists a blood test for acetylcholine receptor antibodies and others, a CT or MRI scan of the chest to look for a thymus tumor, nerve conduction studies, electromyography, pulmonary function tests and an edrophonium test. The practice offers blood work and can start the evaluation, but antibody confirmation, nerve and muscle studies and chest imaging are arranged by referral to a neurologist.

Treatment is specialist care

There is no known cure, and MedlinePlus says treatment may allow periods without symptoms. It lists resting through the day, an eye patch for bothersome double vision, and avoiding stress and heat. Medicines such as pyridostigmine, and for severe symptoms drugs that suppress the immune response, are prescribed by a neurologist, and plasma exchange, immunoglobulin or removal of the thymus are specialist decisions. The encyclopedia also warns that some medicines can worsen symptoms, so ask a provider before you take any new one.

Living with it and working with primary care

Long-term remission is possible, though the encyclopedia says you may have to restrict some daily activities, and people with only eye symptoms may develop generalized weakness over time. Primary care helps with general health, vaccines, other autoimmune conditions and medicine safety while a specialist runs the treatment. Fatigue that does not follow the pattern above is covered in the fatigue guide, and double vision is covered in the blurry vision guide.

Sources

• MedlinePlus Medical Encyclopedia: Myasthenia gravis
• MedlinePlus: Myasthenia Gravis