Treatment for myasthenia gravis and neuromuscular disorders in Minnesota and western Wisconsin

Neuromuscular junction disorders like myasthenia gravis are uncommon conditions that cause muscle weakness and fatigue that can worsen with activity. These conditions can affect your ability to see, talk, walk, lift objects, swallow and even breathe.

There’s no cure for a neuromuscular junction disorder but, with treatment, it’s possible to limit its effect on your daily life. With treatment, the condition may even go into remission.

At HealthPartners and Park Nicollet, we’ll work with you to develop an individualized treatment plan to help you manage your symptoms through medical treatments and your lifestyle.

Neuromuscular junction disorders like myasthenia gravis happen when the connection (or junction) between the muscles and nerves doesn’t work correctly. The muscle groups most commonly affected are those in your eyes, face, throat, neck and limbs. But these disorders can affect any muscle that you can voluntarily control.

Myasthenia gravis is the most common type of neuromuscular junction disorder. It’s usually categorized as either ocular myasthenia gravis (affecting the eye muscles only) or generalized myasthenia gravis (affecting muscles throughout the body).

Myasthenia gravis is slightly more common in women under 40 years old and men older than 60 years old but can affect people of all ages.

Other types of neuromuscular junction disorders include Lambert-Eaton myasthenic syndrome, botulism and congenital myasthenic syndromes.

Symptoms of myasthenia gravis can be a little different for everyone but tend to get worse for a few years before they level off. The most common symptoms are muscle weakness and fatigue. Myasthenia gravis can also affect your appearance, eating, breathing and speaking.

It’s also important to know that myasthenia gravis doesn’t usually cause muscle pain. So if your muscles are sore as well as tired, there’s likely another cause, but you’ll still want to talk to a doctor to get a proper diagnosis.

Myasthenia gravis can affect the muscles that control your eyes and face. For more than half of the people diagnosed with myasthenia gravis, the first noticeable symptom is related to their eyes. If your symptoms are limited to your eyes, you may be diagnosed with ocular myasthenia gravis.

• Droopy eyelid (ptosis) – This is when your upper eyelid droops, sags or falls over your eye. This condition can happen when the muscle that lifts your eyelid becomes overtired. Ptosis can affect one or both eyes.
• Double vision – Weakened eye muscles can cause double vision (horizontal or vertical) which improves when one eye is closed.
• Weak smile – If the muscles around your mouth are affected, the shape of your smile may change.

Myasthenia gravis can affect muscles in the jaw, throat and lungs, making everyday activities more difficult, especially as your muscles become more tired.

• Difficulty speaking –It may be difficult to speak, and your voice may sound soft or nasal.
• Fatigue while chewing – The muscles you use to chew your food might feel sore and tired before you’re done with your meal, especially when eating foods that require more chewing, like steak.
• Difficulty swallowing – It may be difficult to swallow food, drink or take pills. You might choke easily, and when drinking, liquids may come out your nose.
• Breathing problems – Weakened respiratory muscles can make it difficult to breathe. Sometimes the weakness can become so severe that a person needs a ventilator to breathe. This is called a myasthenia crisis, and it requires immediate medical care.

Other neuromuscular junction disorders can have the same symptoms as generalized myasthenia gravis. However, there can be noticeable differences, including:

• Lambert-Eaton myasthenic syndrome – Symptoms of this disorder can also include dry mouth and tingling in the hands or feet.
• Botulism – This disorder can also cause nausea, vomiting and paralysis.
• Congenital myasthenic syndromes – These syndromes are typically identified at birth or early childhood. Signs that parents and caregivers may notice include a weak cry and delayed motor milestones.

Myasthenia gravis is an autoimmune disorder. It’s caused when the body’s immune system produces antibodies that attack the neuromuscular junction.

The thymus gland, which is part of the immune system, may be one reason for this autoimmune response. Scientists believe that in people with myasthenia gravis, a dysfunctional thymus gland may give incorrect instructions to developing immune cells, causing the immune system to attack the neuromuscular junction.

Other causes of neuromuscular junction disorders include genetic mutations, toxins and injuries.

• Gene changes – Congenital myasthenic syndromes are a group of rare hereditary conditions.
• Toxins – Certain toxins, such as botulinum toxin (causing botulism) can affect the neuromuscular junction, leading to muscle paralysis.
• Medications – Some medications can interfere with neuromuscular transmission. These medicines include very high doses of certain antibiotics and muscle relaxants.
• Infections – Certain infections can produce toxins or trigger immune responses that affect the neuromuscular junction.

At HealthPartners and Park Nicollet, we personalize diagnosis and treatment to your needs. We take a team-based approach to your care, so you can get coordinated care from a wide range of experts.

Your care team may include a neurologist specializing in autoimmune and neuromuscular disease, a pulmonologist, acupuncturist and physical therapist. Your team will also include a care coordinator to make sure that you get the care you need when you need it.

Your care team may use different tests to diagnose the condition. They’ll typically start with a physical exam, ask about your symptoms and review your medical history.

• Physical exam –Your doctor may evaluate your reflexes, muscle strength, posture, balance, coordination, vision and sense of touch.
• Blood tests – These tests may be used to check for certain antibodies, enzymes, hormones or other substances that could be signs of a neuromuscular junction disorder.
• Genetic tests –These tests look for gene changes that can be inherited.
• Electromyogram – This test measures the electrical activity your body makes when in motion and at rest. Abnormalities may be a sign of neuromuscular junction disorder.
• Repetitive stimulation testing – This test measures how your muscles respond to repetitive electrical stimulus over time. If the muscle response becomes smaller with each new stimulus, it can be a sign of a neuromuscular junction disorder.
• Ice test – If you have a drooping eyelid, your doctor may place an icepack on your eye for up to two minutes. If your eye looks better after applying the ice, it’s a sign that the eyelid drooping may be caused by a neuromuscular junction disorder.
• Imaging tests – Imaging tests (such as a CT scan or MRI) may be used to check for an enlarged thymus gland, which could indicate myasthenia gravis.

If you’re diagnosed with myasthenia gravis or another neuromuscular junction disorder, your care team will work with you to develop an individualized treatment plan to help manage your symptoms. Treatment can also help lower your risk of heart disease, thyroid disease, diabetes and rheumatoid arthritis – these health conditions can be more likely if you have a neuromuscular junction disorder.

If you have a neuromuscular junction disorder and become pregnant, we can offer suggestions about how to manage your symptoms during pregnancy and parenthood.

It’s likely that your treatment plan will include one or more medications, chosen to treat your specific symptoms. These medications may be used to:

• Reduce immune response – If you have myasthenia gravis or symptoms caused by autoimmune issues, medication may be used to keep your immune system from mistakenly attacking the neuromuscular junction.
• Improve muscle strength – Your plan may include medications to increase the amount of acetylcholine (one of the chemical messengers that help your nerves talk to your muscles) at the neuromuscular junction.
• Provide temporary relief from symptoms – Plasmapheresis is a procedure that filters antibodies from the blood, providing temporary relief from symptoms.

Your care team will also work with you to make sure that you’re not taking medicines for other health conditions that could worsen symptoms caused by the neuromuscular junction disorder.

If you have myasthenia gravis, it’s possible that removing your thymus gland (thymectomy) could make a significant difference in your myasthenia gravis symptoms. After surgery you may be able to control your symptoms without medications or fewer medications. If your thymus gland could be causing your symptoms and you’re interested in surgery, we’ll refer you to one of our thoracic surgeons.

Acupuncture encourages the body to heal naturally from within while improving function and well-being. Our team provides specialized services to help with symptoms of neuromuscular junction disorders. For more information or to schedule an appointment, call 651-254-3200 or email neurowell@healthpartners.com.

We’re here to provide ongoing support for people living with myasthenia gravis or other neuromuscular junction disorders. We’ll work with you to identify lifestyle changes that could help manage your symptoms. These may include:

• Taking regular breaks and naps – This helps to conserve energy and manage fatigue.
• Exercising regularly – Low- or moderate-intensity exercise can help improve muscle strength and build endurance. Your physical therapist will provide personalized recommendations.
• Changing your diet – Eating more healthy fats, lean proteins, fruits, vegetables and fatty fish may help you control your symptoms.