Myasthenia gravis
which attack proteins inside of muscle cells instead of
Weakness that happens when this autoimmune disease
affects the skeletal muscles
 People with myasthenia gravis may wake up feeling
fine, but get progressively weaker as the day goes on
and by the end of the day, they might feel very weak,
sometimes even getting weaker with repetitive
movement
 Myasthenia gravis can affect the extraocular muscles,
which can control movement which can control
movement of the eye as the eye lids, so individuals
might have diplopia or double vision as well as ptosis
or drooping eyelids
Myasthenia Gravis preferentially affects young women in their
20s and 30s and older men in their 60’s and 70’s but the cause
of this odd “bimodal” distribution of age-of-onset isn’t quite
clear.
Etiology
Myasthenia gravis does not run in families and is not
contagious. It usually appears later in life when antibodies in
the body assault normal muscle receptors. This inhibits a
substance that is required to induce muscular contraction.
Pathophysiology
 Autoimmune disease – type 2 hypersensitivity which
causes cytotoxic injury meaning that I results in the
lysis or death, which is mediated by the
autoantibodies, which are antibodies that are specific
for our own cells or proteins
 B-cell bind to nicotinic acetylcholine receptors on the
muscle cells
 Once acetylcholine receptors are bound by the
antibody, they are unable to bind acetylcholine and
therefore they don’t respond to the “contract” signal
from the CNS
 acetylcholine receptors can also activate the classical
complement pathway of the – the complement system
is a family of small proteins that work in an enzymatic
cascade to fight off infections
 the activation of complement causes inflammation
and destruction of the muscle cells and reduces the
amount of acetylcholine receptors on the surface
 now a minority of people with myasthenia gravis
produce another type of harmful antibody called
“muscle specific receptor tyrosine kinase antibodies
the acetylcholine receptors on the muscle cell
surface, but they similarly leads to destruction of
healthy cells
 in very rare cases, myasthenia gravis can present as
a paraneoplastic syndrome which means that an
underlying cancer like bronchogenic carcinoma or
thymic neoplasm (thymoma) generates an immune
response which results in generation of
autoantibodies
 in some cases, if certain muscles are affected,
myasthenic patients can experience myasthenic crsis
Myasthenic Crisis – This is a life threatening manifestation of
disease; decrease muscle function of the muscles that control
breathing
Clinical Manifestation
 Visual problems, including drooping eyelids (ptosis)
and double vision (diplopia)
 Muscle weakness and fatigue may vary rapidly in
intensity over days or even hours and worsen as
muscles are used (early fatigue)
 Facial muscle involvement causing a mask-like
appearance; a smile may appear more like a snarl
 Trouble swallowing or pronouncing words
 Weakness of the neck or limbs
Diagnosis
Blood tests. These tests look for antibodies that may be
present in people with myasthenia gravis.
Genetic tests. These tests are done to check for conditions
that run in families.
Nerve conduction studies. A test called repetitive nerve
stimulation is used to diagnose myasthenia gravis.
Electromyogram (EMG). A test that measures the electrical
activity of a muscle. An EMG can detect abnormal electrical
muscle activity due to diseases and neuromuscular conditions.
Treatment
Acetylcholinerterase inhibitor – degrades acetylcholine, so
acetylcholinesterase inhibitors stop acetylcholinesterase from
breaking down acetylcholine, which ends up in increasing the
concentration of acetylcholine around the muscle cells and
help counteract the effects of acetylcholine receptors
antibodies

 neodtigmine
 pyrodostigmine

Immunosuppressive drugs

 prednisone –which reduces production of the harmful

antibodies

Surgical removal of the thymus

This seems to reduce muscle weakness symptoms even in

people that don’t appear to have any identifiable problems with
thymus gland itself  its possible because helper T cells,
which originate in thymus, help B cells to make antibodies to
the acetylcholine receptors.

Sources:

Myasthenia Gravis. (2021, August 8). Johns Hopkins Medicine.

https://www.hopkinsmedicine.org/health/conditions-and-
diseases/myasthenia-gravis#:%7E:text=Myasthenia
%20gravis%20(MG)%20is%20a,%2C%20mouth%2C
%20throat%20and%20limbs.

Youtube Video

https://www.youtube.com/watch?v=bYGxGdu9MsQ