The underlying pathophysiology of MG involves antibodies that exert their influence on skeletal muscle acetylcholine receptors and impede the normal function of acetylcholine at the neuromuscular junction.3 This disruption impedes normal muscular contraction, leading to fluctuating muscle weakness and fatigue. The thymus gland, which plays a central role in immune system development during childhood by producing T-lymphocytes, is often implicated in the pathogenesis of Myasthenia Gravis. While the thymus normally atrophies after puberty, in many adults with MG it remains enlarged and may contain clusters of lymphoid tissue.1 Some individuals may also develop thymomas. The thymus is thought to contribute to the autoimmune process by generating autoreactive T cells that direct the production of pathogenic antibodies against the acetylcholine receptor. Common features of Myasthenia Gravis include3: • Eye muscle weakness causing ptosis and diplopia. • Bulbar weakness causing dysarthria and dysphagia. • Dyspnea. • Limb weakness. • Fatigability. All of these features can wax and wane, often worsening as the day goes on or with sustained activity. There are a few ways to diagnose myasthenia gravis which include3: • Blood tests. » The main blood test used is very sensitive and specific: acetylcholine receptor antibodies of which there are three types — binding, blocking and modulating. Some labs will only run two of the three. » While uncommon, MUSK is another blood test used. This is almost nonexistent in Utah, but can help diagnose young Black women. • Electrophysiology, specifically repetitive nerve stimulation, can be performed. • Single-fiber EMG. • Imaging, a CT to look for a thymoma, however not useful for diagnosis of MG. • A trial of Mestinon can also help in confirming diagnosis. As seen, there are a few ways to help recognize MG; however, antibody testing has revolutionized its diagnosis. Treatment2 While there is no cure, the following treatments can manage symptoms effectively: • Medications: » Pyridostigmine (brand name Mestinon) is used as a first line, with immediate effect. » Steroids. » Immunosuppressive drugs like azathioprine (brand-name Imuran). » Vyvgart, a new medication that may work with a variety of autoimmune diseases; however, it is very expensive. • IVIG: These are short-term treatments used in some cases. • Very rare, but a thymectomy in which surgical removal of the thymus gland may improve symptoms or lead to remission in some cases. Myasthenia Gravis is treated differently by different specialists but is relatively gratifying to treat, often responding to meds. Conclusion Upon meeting with the neurologist, the initial concerns of MG in the patient were confirmed through the AchR Panel. D.G. was prescribed pyridostigmine, which he is responding well to. He reported that he is able to golf five days a week, give talks in church and no longer sounds like he is hunting wabbits. 1. Bubuioc, A.-M., Kudebayeva, A., Turuspekova, S., Lisnic, V., & Leone, M. A. (2021). The epidemiology of myasthenia gravis. Journal of Medicine and Life, 14(1), 7–16. https://doi.org/10.25122/jml-2020-0145 2. Farmakidis, C., Pasnoor, M., Dimachkie, M. M., & Barohn, R. J. (2018). Treatment of myasthenia gravis. Neurologic Clinics, 36(2), 311–337. https://doi.org/10.1016/j.ncl.2018.01.011 3. Myasthenia gravis. (n.d.). National Institute of Neurological Disorders and Stroke. Retrieved April 6, 2025, from https://www.ninds.nih.gov/health-information/disorders/myasthenia-gravis 4. Phillips, L. H., 2nd. (2003). The epidemiology of myasthenia gravis. Annals of the New York Academy of Sciences, 998(1), 407–412. https://doi.org/10.1196/annals.1254.053 5. Thanvi, B. R., & Lo, T. C. N. (2004). Update on myasthenia gravis. Postgraduate Medical Journal, 80(950), 690–700. https://doi.org/10.1136/pgmj.2004.018903 23
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