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More on Myasthenia Gravis

Neurology and Neuroscience

Myasthenia Gravis

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Myasthenia gravis is a rare autoimmune disease in which the immune system interferes with the transmission of nerve impulses to the muscles, especially those of the eyes, mouth, throat, arms, and legs. People with myasthenia gravis develop severe, sometimes life-threatening, weakness. NewYork-Presbyterian Hospital's neurologists and neurosurgeons work closely with other medical specialists to evaluate and treat patients with myasthenia gravis, offering comprehensive care to manage symptoms and improve quality of life.

Symptoms

Symptoms of myasthenia gravis may include vision problems, severe muscle weakness and fatigue, distortion of the facial muscles, and difficulty swallowing.

Diagnosis

Our doctors diagnose myasthenia gravis using tests such as:

  • Physical and neurological examination
  • Blood tests
  • Electrodiagnostic tests (such as electromyography) which evaluate muscle and nerve function

Medical Treatment

NewYork-Presbyterian physicians have a strong track record treating myasthenia gravis and employ several treatment options:

  • Anticholinesterase medications (neostigmine and pyridostigmine) can enhance the transmission of nerve impulses and increase muscle strength. Often the response to these drugs confirms the diagnosis.
  • Drugs that suppress the immune system (such as prednisone, mycophenylate, and azathioprine) can suppress myasthenia gravis disease activity.
  • Patients with myasthenia gravis who experience periods of extreme weakness may undergo a procedure called plasmapheresis, during which doctors filter abnormal antibodies from the blood, or a treatment called high-dose intravenous immune globulin (IVIg), in which patients receive purified immune system proteins.

Surgical Treatment

The thymus, an immune-system organ under the breast bone, is involved in the development of myasthenia gravis, but its role is not well understood. In the past, the thymus would be surgically removed (a procedure called a "thymectomy") using sternotomy (an operation which required cutting through the breastbone). This would result in a long inpatient stay in the hospital and considerable discomfort after the surgery. NewYork-Presbyterian's thoracic surgeons are experts in performing a newer surgery for myasthenia gravis, one which uses robotic surgery to remove the thymus. The surgeon makes a small incision between the ribs to remove the thymus, resulting in less pain and a shorter hospital stay than that associated with sternotomy. Symptoms improve in as many as 70 percent of patients who have had thymectomy, and it may lead to a cure in some of these patients. These improvements may occur months to years after surgery. Thymectomy is most effective in those under age 60 and early in the course of the disease.

Research

Researchers at NewYork-Presbyterian are participating in clinical studies to define the most effective role of thymectomy in myasthenia gravis treatment.

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