Understanding Myasthenia Gravis It is said that ‘modern people live with chronic fatigue.’ I suffer from fatigue due to tiring work and stress. Some people take it for granted and accept it as their daily routine. However, many diseases are hidden behind chronic fatigue. ‘Myasthenia gravis’ is one of them. In short, it is a disease in which strength is not properly applied to the muscles. It’s easy to feel helpless and think it’s just fatigue at first. In fact, many people miss early signs and diagnosis is delayed. It’s not a matter of energy. It is an autoimmune disease in which the body’s immune system attacks itself. Therefore, there is no specific cause or prevention method. The key is to detect it early and treat it consistently.
To apply force or move a muscle, the brain must send a signal and the neurotransmitter acetylcholine must properly bind to the acetylcholine receptor at the neuromuscular junction where the nerve endings and the muscle connect. However, if antibodies that interfere with the immune system are disrupted, acetylcholine cannot function properly, causing problems with muscle contraction. In other words, myasthenia gravis is a condition in which the nerve impulses that give strength to muscles are not transmitted properly. Any muscle that moves with will can cause problems. Professor Lee Hye-rim of the Department of Neurology at Korea University Guro Hospital said, “Myasthenia gravis is a disease in which commands to apply force are not transmitted well,” and added, “Symptoms can occur wherever voluntary muscles are located.”
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It’s okay in the morning, but gets worse in the afternoon.
The first or most common place where symptoms appear is the eye area. Problems with eyelid muscle contraction cause drooping of the eyelids. Without realizing it, you end up pushing your eyelids up with your fingers. They also complain of double vision, where images overlap, due to eye movement disorders. While driving, you may experience double vision of lanes. Professor Oh-kyung Lim of the Department of Rehabilitation Medicine at Gachon University Gil Hospital said, “The most common thing that appears is ocular myasthenia gravis. The eyes do not open properly as intended and the eyelids droop, but at first, people don’t think much of it and think, ‘Am I too tired these days?’” .
As problems with the masticatory muscles occur, chewing power weakens, making it difficult to chew hard food, and in some cases, swallowing disorders that make it difficult to swallow food may progress. The problem is when it spreads beyond the eyes or face and spreads throughout the body. You may lose strength in your arms or hands, frequently dropping things, and simple daily actions such as brushing your teeth or washing your hair become difficult. Professor Hye-rim Lee said, “In fact, many patients complain that they have difficulty brushing their teeth or washing their hair and need to rest. If left untreated, even combing their hair becomes difficult.” Additionally, in severe cases, breathing problems may occur. Professor Lim explained, “If it affects the respiratory muscles, it can lead to a serious situation that can even lead to respiratory paralysis.”
There are two main characteristics of myasthenia gravis symptoms. One is that symptoms are quiet in the morning, and the second is that symptoms improve with rest. Professor Lee said, “It’s called diurnal variation, so it’s relatively okay in the morning, but it gets worse in the afternoon. The key is that when you continue to use the muscle, the symptoms get worse as you lose strength, and get better when you rest.” “He explained.
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Arbitrary discontinuation of medication may lead to recurrence or worsening.
Therefore, if you have any suspicious symptoms, you should immediately seek medical attention from a specialist. If you visit a neurologist, you can receive an accurate diagnosis along with an examination. Depending on the symptoms, diagnosis can be made through an acetylcholine receptor antibody test (blood test), a repetitive nerve stimulation test, or a tensilon test to check whether muscle strength is gained after drug injection. An ice pack test may be used for patients with pronounced eyelid drooping.
Treatment consists of medication. Three main types of drugs are used: acetylcholine enzyme inhibitors (methinon), immunosuppressants, and steroids. Acetylcholinease inhibitors are used to control symptoms. The effect appears 30 minutes to 1 hour after taking it and lasts for about 3 to 4 hours. Because the effect lasts for a short time, it must be taken three times a day. Azathioprine and Prograb are commonly used immunosuppressants, but they must be taken for more than 3 months to be effective, so it is important to take them consistently. Steroids are used to control symptoms before the effects of immunosuppressants appear, in the early stages (3 to 6 months), or when symptoms suddenly worsen.
However, caution must be exercised as a significant number of patients may stop taking the drug voluntarily due to improved symptoms or side effects of steroids. This causes worsening of symptoms, expansion of the range, and recurrence. Professor Lee said, “Some people are scared because of the word ‘severe’ in the disease name, but it is possible to get pregnant during treatment, and with regular treatment, you can live your daily life.” He added, “If you stop treatment arbitrarily, the situation can get more serious, so it is important to continue.” “Treatment is the key,” he emphasized.
Ryu Jang-Hoon ([email protected])
2024-02-17 13:20:44
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