Myasthenia gravis (MG) causes muscle weakness. Your immune system mistakenly blocks nerve signals, making muscles tired, especially with activity.
What is Myasthenia gravis?
Myasthenia gravis is an uncommon autoimmune neuromuscular disorder marked by fluctuating muscle weakness. At AHN, our neuromuscular specialists have more than 30 years of experience treating patients with this condition. We provide an exceptional level of expertise and work closely with the nonprofit Myasthenia Gravis Association of Western Pennsylvania to provide the education and support you need so you can manage this condition and live a full, active life.
AHN Myasthenia Gravis Clinic
A Myasthenia gravis diagnosis needs dedicated and comprehensive care. At AHN’s Myasthenia Gravis Clinic, you’ll experience an atmosphere that is supportive, innovative, and focused on your specific needs. Your myasthenia gravis treatment will use the latest options to help manage your symptoms and help you live a fuller life.
Why choose AHN for your myasthenia gravis
With a less-common condition like myasthenia gravis, you want to seek care from an experienced team who understand this unique disease. Your Myasthenia gravis diagnosis will be explained, and your treatment options will be discussed and explored to determine your best options. We provide an exceptional level of expertise and work closely with the nonprofit Myasthenia Gravis Association of Western Pennsylvania to provide the education and support you need so you can manage this condition and live a full life. Patients and families choose AHN for our:
- Neuromuscular expertise: Dr. George Small leads our highly regarded neuromuscular provider group for their expertise in treating this treatable condition. We treat hundreds of patients with myasthenia gravis every year, more than any other center in the region — and receive referrals nationally.
- Team approach: Many patients with myasthenia gravis experience breathing disorders and sleep apnea at some point. Because we see a large number of patients with this rare condition, our lung specialists have uncommon expertise treating breathing and other pulmonary complications due to myasthenia gravis.
- Novel therapies: At AHN, you can access the latest FDA-approved therapies, including new medications, as only a dedicated academic center can provide.
- Dedicated Myasthenia Gravis Clinic: At this clinic, you’ll meet with a nurse who focuses on caring for patients with myasthenia gravis. We take the time to answer your questions and provide the support you need, ensuring a high level of personalized care.
- Focus on neuroscience research: Our neuromuscular specialists are active in ongoing research, studying promising newer treatments for myasthenia gravis — in particular, CAR T-cell therapy — in collaboration with the hematologic specialists at our sister Western Pennsylvania Hospital.
- Active support groups: The Myasthenia gravis Association of Western Pennsylvania support groups, where patients with myasthenia gravis meet and gain support from people who have been through similar challenges, are actively attended by Dr. Small, who is a member of the board of directors of the Myasthenia Gravis Association of Western Pennsylvania.
Find us
AHN Neurology - Floor 3 at Hemlock Building
320 E. North Ave, Hemlock Bldg. 3rd Floor
Pittsburgh, PA 15212
Get directions
Myasthenia gravis symptoms and signs
As with many different health conditions, you will likely experience myasthenia gravis symptoms differently that someone else. That’s completely normal, and it’s important to share how you’ve been feeling and the symptoms you’ve been experiencing with your care team. This information will help you and your care team better understand and treat your myasthenia gravis. Common symptoms and signs include:
- Weakening eyes and eyelids, resulting in droopy eyelids or double vision.
- Problems swallowing.
- Fatigue in the neck and jaw.
- Speech impairments.
- Shortness of breath.
- Weakness in the arms, legs, hands, and feet.
Causes and risk factors
Myasthenia gravis causes are due to the nature of the disease. As a chronic autoimmune disease, myasthenia gravis causes weakness in the skeletal muscles because the immune system produces antibodies that attack specific proteins involved in muscle contraction. This prevents your brain's signals from fully reaching your muscles, making them weak and tire out quickly. Your thymus gland, located in your chest and part of your immune system, plays a role in the disease. It is believed the thymus gland can either be too large or small and reacts by instructing the immune system to make the wrong type of antibodies, resulting in myasthenia gravis.
There are some risk factors that are believed to contribute to developing myasthenia gravis. These include:
- Age and gender: Those assigned female at birth often get it when they're younger (under 40), while those assigned male tend to get it later in life (over 60). However, it can happen at any age.
- Other autoimmune conditions: If you have other autoimmune diseases (like rheumatoid arthritis), your risk might be slightly higher.
- Genes: While not directly inherited, a slight genetic tendency can exist.
- Stress, illness, and fatigue: These can sometimes trigger or worsen myasthenia gravis symptoms.
- Certain medications: A few specific medications can sometimes make myasthenia gravis symptoms worse.
Myasthenia gravis screening and diagnosis
Myasthenia gravis can be challenging to diagnose. Our physicians have 30 years of experience recognizing the symptoms, giving us the skills to make a precise diagnosis. At AHN, you have access to the latest tests. Your physician may order one or more of these tests to confirm a diagnosis:
Electromyogram (EMG)
This test measures the electrical activity of muscles.
Nerve conduction studies
This test, always done in tandem with an EMG, measures the nerves’ ability to send electrical signals. We often perform it to potentially diagnose the disorder. A nerve conduction velocity test measures the nerves’ ability to send electrical signals. We often perform it along with an EMG to help determine whether symptoms are related to your nerves or muscles.
These tests are very important for pinpointing issues in the nerve-to-muscle communication, which is key in a myasthenia gravis diagnosis.
Types and stages of myasthenia gravis
Myasthenia gravis can affect people in different ways. Doctors often classify it into types based on which parts of the body are affected, as well as myasthenia gravis stages to describe how severe the condition is and how it progresses over time.
The main types of MG are defined by which muscles are involved:
- Ocular Myasthenia gravis: This type affects only the muscles around the eyes. You might experience droopy eyelids (ptosis) or double vision (diplopia). These symptoms can fluctuate throughout the day.
- Generalized myasthenia gravis: This is the most common type, where muscle weakness extends beyond the eyes to other parts of the body. In addition to eye symptoms, you might experience weakness the face and throat, neck and limbs, and breathing muscles.
- Congenital myasthenia syndromes (CMS): This is a very rare form of myasthenia gravis that is not autoimmune. Instead, it's caused by a genetic defect that affects the way nerves and muscles communicate. The condition and muscle weakness are usually present from birth or early childhood.
Stages of Myasthenia Gravis
Doctors often use a staging system to describe the severity and progression of myasthenia gravis. The most common is the Osserman classification, which can be simplified into these general stages:
- Stage I ocular myasthenia gravis: Weakness is limited to the eye muscles only.
- Stage IIa mild generalized myasthenia gravis: Weakness is mild and affects muscles beyond the eyes (like face, throat, limbs). Breathing muscles are not affected.
- Stage IIb moderate generalized myasthenia gravis: Weakness is more pronounced and affects muscles beyond the eyes. Chewing, swallowing, speaking, and limb weakness might be more noticeable. Breathing muscles are not affected.
- Stage III acute severe generalized myasthenia gravis (myasthenic crisis): Rapid and severe onset of generalized weakness, including significant weakness in the breathing muscles. This is a medical emergency requiring immediate hospitalization and intensive care to support breathing.
- Stage IV chronic severe generalized myasthenia gravis: This applies to patients who have had severe generalized weakness for a long time, often leading to chronic disability despite treatment. This stage is less common with modern therapies.
Understanding the stages, can help you better understand your myasthenia gravis diagnosis.
Myasthenia gravis treatment
Often, patients find that a combination of therapies effectively controls their symptoms. We also provide specialized inpatient services for people who require more intensive care, such as assistance walking, speaking, or breathing.
After a thorough physical evaluation and diagnostic tests, we develop a treatment plan that addresses your symptoms and concerns. Your treatment plan may include:
- Medication: Your physician will help determine which medications would most benefit you. Some medications relieve your symptoms by reducing the antibodies in your body, and alternative, newer therapies help spare patients the complications of long-term steroid therapy.
- Plasmapheresis: This therapy, also called plasma exchange, filters your blood through a machine that removes harmful antibodies (similar to dialysis).
- Immunoglobulin therapy: You receive an injection of high doses of good antibodies from healthy donor blood. These new antibodies help block the antibodies that may be attacking your nervous system. These often include:
- FCRN inhibitors: These are used as a potential steroid-sparing agent, and some patients may benefit from a self-injectable form of this medication, allowing travel and work, as well as potentially minimizing significant changes to your life.
- Infusion therapies: These treatments involve receiving medication through an IV, either at an infusion center or sometimes even at home. They work by calming down your immune system in specific ways, helping your nerves and muscles communicate better to maintain strength.
- B-cell suppression therapy: These medications target specific cells in your immune system (called B-cells) that are involved in producing the antibodies that cause myasthenia gravis.
- CAR-T cell therapy: Dr. Small has participated in a CAR-T cell experimental protocol, a therapy that is regularly employed by our oncology colleagues at West Penn Hospital to extend the life of patients.
Myasthenia gravis FAQs
Receiving a myasthenia gravis diagnosis can bring many questions and concerns, and at AHN, we are here to provide comprehensive support and information every step of the way. We understand the challenges that come with this autoimmune condition, and our dedicated team is committed to helping you understand your diagnosis, explore effective myasthenia gravis treatment options, and manage your health with confidence. You'll find clear, reliable information about myasthenia gravis causes and a detailed overview of common myasthenia gravis symptoms to help you better understand this condition. While we're always available to answer your specific questions, our goal is to empower you with essential knowledge up front, ensuring you feel informed and supported as you navigate your care journey with AHN.
How to reverse myasthenia gravis?
Since Myasthenia gravis is an autoimmune disorder, there currently is no known way to cure or reverse the condition. Treatment innovations have allowed for it to be more effectively managed and allow many individuals who have a myasthenia gravis diagnosis to live full and active lives. The primary goals of myasthenia gravis treatment are to improve muscle strength and control the immune system's attack on the neuromuscular junction. This is typically achieved through:
- Symptomatic treatments: These help improve muscle strength quickly, such as cholinesterase inhibitors.
- Immunosuppressive therapies: These aim to suppress the abnormal immune response.
- Rapid-acting therapies: For severe or sudden worsening of symptoms, treatments like intravenous immunoglobulin (IVIG) or plasma exchange (plasmapheresis) can provide temporary relief.
- Thymectomy: Surgical removal of the thymus gland, which is often abnormal in myasthenia gravis patients, can lead to improvement or remission for some individuals.
How common is myasthenia gravis?
According to the Myasthenia Gravis Foundation of America, the condition affects between 150 to 200 out of every million people.1 While it can occur at any age, most people who are assigned female at birth will have myasthenia gravis symptoms begin in their 20s and 30s, while those assigned male at birth will experience symptoms after age 50.
Is myasthenia gravis hereditary?
No, a myasthenia gravis diagnosis is generally not considered hereditary in that it is passed from a parent to a child. There is, however, a genetic predisposition that can make an individual more likely to receive a myasthenia gravis diagnosis. This means that while you don't directly inherit myasthenia gravis, certain genes can make an individual more susceptible to developing the condition. It's thought to be a complex interaction between these genetic factors and environmental triggers that ultimately leads to the development of the condition.
Contact us
To schedule an appointment as a new patient or learn more about services at the AHN Myasthenia gravis Clinic, call 412-359-8850.