How Is Myasthenia Gravis Diagnosed?
DiagnosisThere are several tests that a doctor may recommend to diagnose myasthenia gravis. These can include:
- Physical and neurological examination. Your doctor will review your medical history and test your reflexes and coordination, muscle tone and strength, sense of sight and touch, and balance.
- Genetic tests. Although most cases of myasthenia gravis are not genetically inherited, a small subset may be. Genetic tests may be conducted to identify if this is the case.
- Responses to medications. A response to certain medications such as anticholinesterases may help confirm a diagnosis of myasthenia gravis. These medications can enhance the transmission of nerve impulses, resulting in increased muscle strength. Seeing improvements after receiving this medication may help the doctor with the diagnosis of your condition.
- Blood tests. These can reveal the presence of antibodies that are associated with this condition. High levels of these antibodies are a strong indicator of a positive myasthenia gravis diagnosis.
- Nerve conduction studies. Electrodes will be attached to your skin in order to send electrical pulses to your muscles. With repeated stimulation, doctors can see if your nerves’ ability to send signals to the muscle diminishes with fatigue.
- Pulmonary functioning tests. These tests can determine whether your condition is impacting normal breathing.
- Ice test. If a drooping eyelid is one of your symptoms, a doctor may place a bag of ice over it for a short period of time to cool the muscles affected by myasthenia gravis. This may temporarily improve muscle weakness in some cases of myasthenia.
How Is Myasthenia Gravis Treated?
TreatmentAlthough myasthenia gravis cannot be cured, there are several treatment options available for individuals affected by this condition. These can include medications, surgical treatments, and a range of other therapies. The physicians at NewYork-Presbyterian have experience providing the most cutting-edge treatments for myasthenia gravis.
Medications
Anticholinesterase medications (neostigmine and pyridostigmine) can enhance the transmission of nerve impulses and increase muscle strength. Seeing improvements after receiving medication may help the doctor with a diagnosis.
Drugs that suppress the immune system (such as prednisone, mycophenolate, and azathioprine) can suppress myasthenia gravis disease activity.
Surgical options
The thymus is an immune system organ located in the upper chest beneath the breastbone and is believed to be involved in the development of myasthenia gravis. Many people with myasthenia gravis have tumors on the thymus gland, or the gland is inflamed or has other abnormalities preventing it from functioning properly. The removal of this gland has been shown to benefit many individuals affected by myasthenia gravis.
In the past, the thymus would be surgically removed in a procedure called a thymectomy using an operation that 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 procedure for myasthenia gravis treatment, using robotic surgery to remove the thymus. This minimally invasive procedure does not require the opening of the chest, resulting in a far quicker recovery time and less discomfort after the surgery. A small incision is made between the ribs to remove the thymus using a highly precise robotic system controlled by the surgeon. Symptoms improve in as many as 70 percent of patients who undergo this procedure. These improvements may occur months to years after surgery. A thymectomy is most effective early in the course of the disease and for those under the age of 60.
Other therapies
Patients with myasthenia gravis who experience periods of extreme weakness may undergo a procedure called plasmapheresis. This procedure resembles dialysis treatments and involves the filtering of blood through a machine that removes abnormal antibodies causing interference in the transmission of nerve signals to your muscles. However, the benefits of this procedure are usually quite temporary, and repeated procedures can become increasingly difficult as veins are harder to access over time.
Another myasthenia gravis treatment option called high-dose intravenous immune globulin (IVIg) involves patients receiving purified immune system proteins. This treatment can alleviate symptoms of myasthenia gravis by reducing the immune system’s interference with the nervous system.
Monoclonal antibody treatments may also be recommended, particularly for patients who are not responding well to other treatments. Monoclonal antibodies resemble the antibodies created naturally in the body but are in fact produced in a laboratory. These can target and suppress certain elements of the immune system in order to alleviate symptoms of myasthenia gravis.
Research
Ongoing research at NewYork-Presbyterian is being conducted to advance the understanding and treatment of myasthenia gravis. Researchers are currently participating in clinical studies to define the most effective role of thymectomy in myasthenia gravis treatment.
Trust NewYork-Presbyterian for Myasthenia Gravis Treatment
Our team of dedicated health care experts understands the symptoms of myasthenia gravis and can provide you with the individualized care and treatment you need. Schedule an appointment to connect with one of our health care providers and learn more about the services NewYork-Presbyterian offers.