Living with myasthenia gravis (MG) involves managing a range of symptoms that can vary in severity depending on the day.
Muscle weakness often worsens with fatigue, and other physical and environmental factors can also cause symptoms to fluctuate. Avoiding these triggers is essential to reducing the frequency of symptom episodes and the severity of symptoms so you can get back to feeling your best.
What is MG?
Myasthenia gravis (MG) is a chronic neuromuscular disorder that affects approximately 150 to 200 people per million. It is an autoimmune disease that occurs when the body mistakenly attacks the neuromuscular junction, interrupting the communication between the nerves and muscles in the face, throat and diaphragm.
What symptoms are common?
Common symptoms include, drooping eyelids, blurred or double vision, slurred speech, flat facial expressions, weakness in the arms, hands, fingers, legs and neck, shortness of breath as well as difficulty chewing and swallowing. Treatment focuses on managing symptoms through medication and lifestyle changes to avoid triggers.
What causes MG symptoms to fluctuate?
People living with MG will become familiar with the different factors that can trigger symptom flare-ups. Fluctuations in the severity of symptoms can occur from one day to the next, but also within the space of one day.
Fatigue: This is the most common factor and can cause symptoms to worsen as a result of too much physical activity or as the day progresses. For example, in the morning, speech is clearer, but by the afternoon or evening, speech is slurred.
Stress/anxiety: The emotional impact of stress and anxiety can reduce neuromuscular efficiency, disrupt sleep and lead to fatigue. It can also impair sleep.
Hormonal changes: The menstrual cycle, pregnancy and menopause can exacerbate symptoms, as changes in estrogen and progesterone can stimulate antibody production. Neurotransmitter levels may also be affected.
Infections/illness: These can stimulate the activity of the immune system and cause more antibodies to be produced.
Temperature: Very hot temperatures, humidity and intense sunlight can exacerbate symptoms as they can impair neuromuscular transmission. Over the summer months, MG symptoms can therefore worsen.
Severe symptom flare-ups in MG
A severe symptom flare-up known as a myasthenic crisis can be triggered by infection, high-steroid therapy or insufficient treatment. It causes paralysis of the respiratory muscles and requires urgent respiratory support and acute care, with respiratory failure often requiring intubation and mechanical ventilation. A myasthenic crisis can be a life-threatening complication of MG if not treated urgently. It only occurs in 15% to 20% of myasthenic patients.
Remission in MG
In some people living with MG, the disease may go into temporary or permanent remission. In this case, symptoms go away completely as a result of treatment or surgery.
