Myasthenia gravis: symptoms, causes and which doctor to see

For myasthenia gravis you can first see: Neurology. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: eyelid drooping that worsens during the day, especially in the evening; double vision; the voice weakening while speaking, nasal speech; difficulty chewing and swallowing; weakness of the arms and legs that increases with use. Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

Do not take new medicines, especially some antibiotics, without asking your doctor.

The most common causes: the immune system producing antibodies against receptors at the nerve-muscle junction; enlargement of the thymus gland or a thymoma; infection, stress, surgery and certain medicines can trigger attacks. Only a doctor’s examination can determine the exact cause.

Myasthenia gravis is chronic, but today medicines, immune-modulating treatments and, if needed, removal of the thymus gland allow most patients to live close to normally.

It is more common in: women aged 20–40 and men over 60; people with other autoimmune diseases.

The diagnosis uses acetylcholine receptor antibodies in the blood and EMG, which measures nerve-muscle transmission (repetitive stimulation, single-fibre EMG). A chest CT is taken to assess the thymus gland.

The disease cannot be prevented; avoiding infections, regular treatment and attention to drug interactions reduce attacks.

See neurology; if eye findings dominate, ophthalmology also assesses it.

Crises affecting the breathing muscles need emergency treatment, but with proper treatment and follow-up the vast majority of patients have a normal life expectancy.

If the answer to any of these questions is yes, call 112 without delay: “Are you struggling to breathe?” “Are you unable to swallow your saliva or choking often?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: for eyelid drooping or double vision that worsens during the day; within a few days if difficulty swallowing and speaking has started.