Myasthenia gravis is a neuromuscular disease of an autoimmune nature, the main sign of which is pathologically rapid fatigability of the striated muscles (those that form the skeletal muscles). The pathology is very serious, often accompanied by dangerous crises. Recently, the incidence rate has been growing - there are 7-8 cases per 100,000 people.
Why does myasthenia gravis occur? What symptoms point to it? How is she treated? This is now worth mentioning.
Disease characteristics
Before proceeding to the consideration of the symptoms and causes of myasthenia gravis, it is necessary to discuss what exactly is this disease, which is also called asthenic bulbar paralysis. In fact, this is increased fatigue of the muscles and their pronounced weakness. The reason is the defeat of cholinergic receptors concentrated in postsynaptic membranes. Pathology can affect any muscle, but the neck, tongue, pharynx, face and eyes are usually affected.
Causes
Doctors have not fully figured out why the disease occurs. Many are inclined to the fact that there is a hereditary factor, but this is not proven. But the fact that this ailment is combined with a tumor of the thymus gland or with hyperplasia is a fact.
Also, the causes of myasthenia gravis, the symptoms of which are listed below, include:
- Organic diseases affecting the nervous system (for example, amyotrophic lateral sclerosis).
- Dermatomyositis. This is a disease of the entire muscle system of the body, accompanied by the inflammatory and degenerative changes that occur in it.
- Cancer of the breast, ovary, prostate and lung.
- Sleeping sickness.
- Thyrotoxicosis.
It is important to note that myasthenia gravis affects women more often. Men suffering from this disease are half as many. As for the age category, people at the age of 20 to 40 are at risk.
Manifestations of the disease
Symptoms of myasthenia gravis are specific, so it is difficult to confuse them with signs of any other disease. They begin to manifest themselves in stages, and here is what usually happens and in what order:
- Weakness of the facial, pharyngeal and masticatory muscles.
- Fast fatiguability. A person gets tired even after the simplest manipulations with his hands or walking.
- Low mobility.
- Weight loss and physical exhaustion.
- Violation of swallowing (dysphagia).
- Change of facial expressions and gait.
- Weakness of the neck and respiratory muscles.
- Violation of the sensitivity of the tongue, pharynx and lips.
- Eyelids weakening and vision impairment.
During the day, the severity of symptoms changes, and the well-being of a person after prolonged muscle tension significantly worsens. In the morning, a person can feel healthy and alert, but after a few hours he begins to feel tired, which progresses very quickly.
Eye shape
Symptoms of myasthenia gravis should be considered separately. With this form of the disease, the following are affected:
- Ocular muscles.
- The muscle that lifts the upper eyelid.
- Circular muscle of the eye.
Therefore, the main manifestations are:
- Inability to look at objects too far or too close.
- Strabismus.
- Doubling in the eyes.
- Difficulties in focusing.
- The omission of the upper eyelid (ptosis).
Ophthalmic disease may be localized. That is, it will not switch to other muscle groups and organs. Experts say that if over the next two years the process does not cover other anatomical zones, then the patient’s life is not at risk.
However, the prognosis is not always so good with myasthenia gravis. Often the disease progresses, and this manifests itself in the frequent onset of muscle fatigue and in too long a set of forces.
Pathologies of other species
Fatigue of the chewing and facial muscles, as well as the muscles that are responsible for speech, leads to unpleasant consequences. Among them:
- Voice change.
- Difficulty eating.
- Difficulties associated with speech and pronunciation.
- The voice becomes deaf, "nasal". It seems that the person is talking with his nose pinched.
- Fatigue, even from a short conversation. After a five-minute conversation, a person may need several hours to rest.
- Chewing muscle weakness. A person is not able to eat solid food.
The type of myasthenia gravis in which the muscles of the pharynx are affected is more dangerous. Because a person with such a pathology is not able to take liquid food. Every attempt to drink ends with a person choking on it. If the patient suffocates, then water enters the respiratory tract, as a result of which aspiration pneumonia begins to develop.
But the most dangerous condition is generalized myasthenia gravis. It is it that provides 1% mortality among people suffering from this pathology. A symptom of myasthenia gravis of this form is the weakness of the respiratory muscles, which causes respiratory distress. As a result, acute hypoxia and, as a result, death can occur.
Diagnostics
Well, the classification of myasthenia gravis is clear, now we can talk about what kind of research is being done to determine this disease.
The most revealing procedure is the proserin test. It is this study that gives the neurologist about the disease the greatest amount of information. How is everything going? First, a person is examined to assess what condition his muscles are in. Then Prozerin is injected subcutaneously, a synthetic preparation whose active substance is neostigmine methyl sulfate.
This medication prevents the destruction of acetylcholine secreting neurons. As a result, the impulse reaches the muscles, and the patient's strength is restored. Usually the action occurs after 30-40 minutes - then the doctor and examines the patient again to find out how his body reacted to the drug.
In addition, electromyography is performed, during which the electrical activity of the muscles is recorded. It is carried out twice - before the introduction of Prozerin into the blood and an hour after that. This study allows us to determine whether the problem is really a violation of neuromuscular transmission, because the reason may lie in a violation of the function of an isolated nerve or muscle.
In the event that, after electromyography, the doctor has doubts about the nature of the ailment, the patient is sent for electroneurography, aimed at studying the conductive ability of nerves. In addition, a specialist cannot diagnose myasthenia gravis in adults without examining the results of a blood test (general and biochemical).
Computed tomography of the mediastinal organs also provides a lot of valuable information. It is often carried out, since the appearance of myasthenia is often associated with volumetric processes in the thymus gland. And, of course, the patient will definitely need to undergo differential diagnostics so that the doctor can rule out all diseases that have similar symptoms.
Modern drugs
Now we can move on to the topic of treatment of myasthenia gravis. There are many modern drugs that help to maintain working capacity, improve the quality of life and avoid disability. What exactly will need to be taken to a person - the doctor determines, based on the results of the diagnosis.
As a rule, such drugs are prescribed:
- Sonapaks. It affects the peripheral and central nervous system, has a tranquilizing, antipsychotic, antidepressant effect. Reduces feelings of anxiety and tension.
- "Chlorophyll". A natural remedy that helps raise vitality and saturate tissues with oxygen.
- "Actovegin." Improves the central nervous system and dilates the coronary vessels.
- "Spazmalgon." It has a direct effect on the smooth muscles of internal organs, relaxes it, relieves pain.
- "Fortalgin." It inhibits platelet aggregation, has an antipyretic, analgesic and anti-inflammatory effect.
- Voltaren. It is used to eliminate inflammation and pain, increase the mobility of joints and muscles.
- Ibuprofen. It increases the range of motion in the joints, reduces morning stiffness.
- Ketoprofen. It inhibits the activity of neutrophils, stabilizes lysosomal membranes, and has anti-bradykinin activity.
- Coldrex. Reduces swelling of the mucous membranes and sinuses of the nose, helps to facilitate breathing, has a tonic effect, replenishes the supply of vitamin C in the body.
- Tempalgin. It has a sedative, analgesic and anti-inflammatory effect.
Only a doctor can prescribe treatment for myasthenia gravis. Self-manifestation in this regard is very dangerous. A person, after listening to the recommendations of people who are not doctors, can take something wrong - “Aminazin”, for example, or “Amitriptyline”. They, like Sonapax, are also antipsychotic drugs. But these drugs have a completely different effect. They relax, stop psychomotor agitation and lower motor activity. And this will greatly aggravate the course of the disease.
How to increase the strength of the body?
With myasthenia gravis, human immunity is greatly reduced. And you can not do without increasing the body's defenses, otherwise there is a risk of functional changes.
As a rule, patients are prescribed infusions of immunoglobulins, which are obtained from donated blood. The most harmless drugs are:
- "Intraglobin."
- "Pentaglobin."
- Gamimun-N.
- "Octagam 10%."
If a patient suddenly has a crisis, then immunoglobulins are prescribed only after emergency resuscitation. But regular intake of these drugs can prevent the development of serious complications. They are usually administered once every two days. The exact dosage is prescribed by the doctor.
It is necessary to take these drugs with caution. Often, the patients to whom they are prescribed complain of headache and nausea. As a rule, this is a reaction of the body to a change in the number of T cells in the blood. After research, you can notice defects in immune particles, as well as increased activity of humoral thymic factors.
Diet
It is very important to follow proper nutrition for myasthenia gravis. Indeed, together with food and drink, a variety of substances and elements enter the human body. With such a serious illness, they should be useful.
Recommendations on nutrition will be provided by the doctor after the diagnosis of myasthenia gravis. But in general, with this ailment, a person needs to consume as much potassium as possible, since it helps restore muscle function. Its sources are:
- Fresh fruits: melon, bananas, oranges, avocados.
- Fresh vegetables: pumpkin, potatoes, rutabaga.
- Legumes: lentils, lima and beans.
- Grain (not crushed).
- Parsnip (you can make infusions from it).
- Raisins and dried apricots.
The body also needs calcium. It increases the excitability of nerve tissues, muscle contractility, strengthens teeth and bones. This is important, because people suffering from myasthenia are prone to injuries. The body receives calcium from such products:
- Dairy products.
- Cauliflower and turnip (and its leaves).
- Lentils, legumes, asparagus.
- Nuts.
- Yolks of eggs.
- Figs
- Soft bones of salmon and sardines.
In order to better absorb calcium, it is recommended to use its sources along with products that contain phosphorus. This is cottage cheese, meat, brains, cheese, beef liver, fish, walnuts, eggs, as well as oatmeal, barley and buckwheat.
Contraindications for myasthenia gravis
There are a number of what to do with this disease is prohibited. The main contraindications include:
- Serious physical exertion.
- The use of curariform muscle relaxants.
- Long exposure to direct sunlight.
- The use of tranquilizers. An exception is the tool "Grandaxinum".
- Taking medications that contain magnesium.
- The use of diuretics. The only exception is Spironolactone.
- The use of antipsychotics.
- Use of fluoride-containing corticosteroids.
- Taking antibiotics belonging to the group of aminoglycosides or fluoroquinolones.
- The use of drugs that are derivatives of quinine.
- Taking funds with D-penicillamine.
And, of course, it is forbidden to ignore medical advice. If the patient wants to improve the quality of life, then he should not engage in self-medication.
Forecast
Much has been said about the symptoms of myasthenia gravis. What are the predictions for such a serious illness? Unfortunately, it cannot be cured completely. And if a person ignores its manifestations and does not turn to a neurologist for adequate treatment and clinical recommendations, myasthenia gravis will develop further. This can result in complete atrophy of the muscle system, which leads to death.
Also, with the development of the disease, the risk of sudden cardiac arrest increases. Fortunately, in our time there are many proven methods that allow you to maintain a person’s quality of life at the proper level and even introduce myasthenia gravis into a stage of prolonged remission.