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Myasthenia Gravis is an auto immune disease which is characterised by weakness and rapid fatigue of the muscles which are under our voluntary control. It is caused by a breakdown in the mechanism which our nerves communicate with the muscles.
Antibodies
In patients with Myasthenia Gravis, the body’s immune system develop auto antibodies that block or destroy neurotransmitter receptor site and therefore signals from nerves to muscles are not able to pass through the junction of the nerve with the muscle known as neuromuscular junction. This results in muscle weakness, which manifests as symptoms of myasthenia. Consulting the Best Thoracic Surgeon in India can help in diagnosing and managing such conditions effectively. The commonest antibody is the Acetylcholine receptor antibody (AChR-Ab). Another antibody called muscle specific Tyrosine Kinase Antibody (MuSK-Ab).
Thymus Gland
Thymus gland is a small gland located in the space between the breast bone and the heart. It is a part of the body’s immune system and believed by researchers to trigger or maintain the production of antibodies that cause myasthenia gravis. It is relatively large sized in infancy and gradually decreases in size after adolescence. In some adults with myasthenia gravis, however, the thymus gland is abnormally large. About 10-15 % of patients with myasthenia have a tumour of the thymus gland which is known as thymoma.
Myasthenia Gravis can affect any age group. But is more common in women younger than 40 and in men older than 60. The hallmark of myasthenia gravis easy fatiguability and weakness of muscles under our voluntary control. Because symptoms usually improve with rest, muscle weakness can come and go. But most commonly affected muscles are:-
Nearly 50 % 0f patients with myasthenia gravis have symptoms related to involvement of eye muscles as their first problem. These include:
Some patients on the other hand may have the first symptoms involving the face and throat muscles, such as:
Combing hair, getting up from chair may become difficult Walking may be trouble some
In extreme cases (myasthenic crisis) the muscles involved in breathing maybe involved leading to difficulty in breathing that may require urgent hospitalisation and ventilatory support.
History and Clinical Examination – The doctors review the patient symptoms by the way of a detailed medical history and conduct a physical examination. One the diagnosis is suspected, it can be confirmed by various tests. These include:
Myasthenia Gravis (MG) is a chronic autoimmune disorder that affects the communication between nerves and muscles, leading to muscle weakness and fatigue. Accurate diagnosis is crucial for effective treatment and management. Here's how Myasthenia Gravis is diagnosed:
A thorough clinical examination by a neurologist is the first step. The doctor will review your medical history, ask about your symptoms, and perform a physical exam to assess muscle strength and reflexes. Specific signs, such as drooping eyelids (ptosis) and muscle weakness that worsens with activity, are key indicators of MG.
Blood tests are essential for detecting specific antibodies associated with Myasthenia Gravis. The most common antibodies tested include:
Electromyography (EMG) measures the electrical activity of muscles and can help identify abnormal muscle function typical of Myasthenia Gravis. Repetitive nerve stimulation and single-fiber EMG are specialized tests used to detect neuromuscular transmission defects.
Imaging studies, such as a CT scan or MRI, may be performed to check for thymomas (tumors of the thymus gland), which are associated with MG. These scans provide detailed images of the chest and help in evaluating the thymus gland.
The Edrophonium test involves administering a drug called edrophonium chloride, which temporarily increases the levels of acetylcholine at the neuromuscular junction. Improvement in muscle strength following the injection suggests Myasthenia Gravis.
The ice pack test is a simple, non-invasive procedure often used when ptosis is present. Applying an ice pack to the drooping eyelid for a few minutes can temporarily improve muscle strength in MG patients, aiding in diagnosis.
Since Myasthenia Gravis can affect the respiratory muscles, pulmonary function tests may be conducted to assess breathing strength and lung capacity. This helps in evaluating the extent of respiratory involvement.
Early and accurate diagnosis of Myasthenia Gravis is vital for managing the disease effectively. If you experience symptoms like muscle weakness, drooping eyelids, or difficulty swallowing, consult a neurologist for a comprehensive evaluation. Understanding the diagnostic process empowers you to take proactive steps in managing Myasthenia Gravis.
If you suspect you might have Myasthenia Gravis or need more information, contact our specialized team today for an appointment and personalized care plan.
Several treatment options are used either alone or in combination to relieve the symptoms of myasthenia gravis. The treatment options include:
Cholinesterase Inhibitors Medications such as pyridostigmine (Mestinon, Myestin, Distinon) improve the transmission of impulses at the neuromuscular junction, thereby improving muscle weakness. These offer only symptomatic relief and do not cure the disease.
Corticosteroids Corticosteroids such as prednisone inhibit the immune system, limiting antibody production. Prolonged use of corticosteroids, however, can lead to serious side effects, such as bone thinning, weight gain, diabetes, and an increased risk of infections.
Immunosuppressants Some patients may need medications that alter the immune system, such as azathioprine (Azoran, Imuran), mycophenolate mofetil (Cellcept), cyclosporine, methotrexate, or tacrolimus (Astrograf XL, Prograf). These drugs, which can take months to work, might be used with corticosteroids. Side effects of immunosuppressants, such as increased risk of infection and liver or kidney damage, can be serious.
The following therapies are usually used in the short term to treat a sudden worsening of symptoms or before surgery or other therapies.
PlasmapheresisThis procedure uses a filtering process similar to dialysis. Your blood is routed through a machine that removes the antibodies that block transmission of signals from your nerve endings to your muscles' receptor sites. However, the positive effects usually last only a few weeks, and repeated procedures can lead to difficulty accessing veins for treatment.
Intravenous Immunoglobulin (IVIg) This therapy provides your body with normal antibodies, which alters your immune system response. Benefits are usually seen in less than a week and can last three to six weeks.
Monoclonal Antibody Rituximab (Rituxan) and the more recently approved eculizumab (Soliris) are intravenous medications used in some cases of myasthenia gravis. These drugs are usually used for people who don't respond to other treatments. They can have serious side effects.
There is no known permanent cure for myasthenia gravis. However, research studies have shown that the surgical removal of the thymus gland (thymectomy) can lead to significant and long-lasting improvement in symptoms. For patients with myasthenia gravis without thymoma, thymectomy can lead to remission (no requirement for any kind of medication) in approximately one-third of patients, significant reduction of symptoms in another third, and no change in the remaining third. Thus, a significant proportion of patients will benefit from thymectomy. However, the effects of thymectomy may take anywhere from six months to several years to appear.
For patients with thymoma surgical removal is indicated irrespective if the fact whether they have myasthenia gravis or not.
A thymectomy can be performed as an open surgery or as a minimally invasive surgery. The main types of thymectomy include:
Open Transsternal Thymectomy In this traditional approach, the surgeon splits the central breastbone (sternum) to open the chest and remove the thymus gland. This method allows for complete removal of the thymus and is often used when extensive surgery is required.
Minimally Invasive Surgery Minimally invasive surgery to remove the thymus gland uses smaller incisions. It might also involve:
Video-Assisted / Thoracoscopic Thymectomy In one form of this surgery, surgeons make a small incision in your neck or a few small incisions in the side of your chest. They then use a long, thin camera (video endoscope) and small instruments to see and remove the thymus gland.
Robot-Assisted Thymectomy In this form of thymectomy, surgeons make several small incisions in the side of your chest and remove the thymus gland using a robotic system, which includes a camera arm and mechanical arms. This is currently the most advanced method for removing the thymus gland and offers much less morbidity while avoiding cutting the breastbone.
We specialize in robotic thymectomy and have vast experience in the removal of the thymus gland using the surgical robot. These procedures might cause less blood loss, less pain, lower mortality rates, and shorter hospital stays compared with open surgery.
The treatment cost for Myasthenia Gravis in India varies based on the severity of the condition, treatment approach, and healthcare facility. Typically, the cost ranges between ₹1,00,000 to ₹4,00,000 for initial treatment, which may include diagnosis, medications, and hospitalization. Long-term management costs depend on the use of immunosuppressants, plasma exchange, or advanced therapies like IVIG (Intravenous Immunoglobulin). Surgical options such as thymectomy, often recommended in certain cases, can cost between ₹2,00,000 to ₹6,00,000. India’s healthcare system offers both cost-effective public hospitals and high-quality private facilities, making it an accessible destination for domestic and international patients. Here is a breakdown of the typical costs:
| Treatment Type | Estimated Cost (₹) |
|---|---|
| Initial Consultation and Diagnosis | 5,000 - 15,000 |
| Medications (Monthly) | 3,000 - 10,000 |
| IVIG Therapy (Per Session) | 1,00,000 - 2,50,000 |
| Plasma Exchange (Per Session) | 50,000 - 1,50,000 |
| Thymectomy (Surgical Procedure) | 2,00,000 - 6,00,000 |
| Hospitalization (Per Day) | 5,000 - 25,000 |
The costs can vary across cities and hospitals, with metro cities like Delhi, Mumbai, and Bangalore often offering a broader range of advanced treatment options.
If you or a loved one has been diagnosed with myasthenia gravis, it is crucial to understand the available treatment options. Our specialized team is here to provide you with the most advanced and effective treatments to manage and alleviate the symptoms of this condition.
For more information or to schedule an appointment, please contact us today.
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