Your unusual fatigue : May be an indication of Myasthenia

Dr KK Pandey *

If you feel extremely exhausted or lifeless even after undertaking a very short walk or exercise, or even combing your hair becomes difficult or a very light work makes you terribly fatigued, you probably might be suffering from an autoimmune disease called Myasthenia Gravis. This myasthenia disease is either a hereditary or may be caused by an excessive physical exertion or infection.

Sometimes exposure to an excessive heat or cold may be responsible for this disease. Adolescent girls just before and after menarche (first menstruation) may develop myasthenia. At times, extreme degree of excitement and tension may lead to onset of myasthenia. Myasthenia may affect both males and females of any age group, but females are more affected & that too at an early age.

Why does Myasthenia occur?

In Myasthenia Gravis, there occurs a deficiency in the patient’s blood of a chemical called Acetylcholine receptor, which is responsible for keeping your body muscles active and energetic. Because of low level of this Acetylcholine receptor in the blood, muscles become lethargic and inactive. The main reason of deficiency of this Acetylcholine receptor in the blood is the excessive accumulation of a destructor element in the blood called Ach R antibody.

This antibody keeps on destroying the Acetylcholine receptor, the activator and energizer of muscles. Because of continued destruction of this muscle activator substance in blood, muscles get exhausted very early even after a short walk or a mild exercise and reach eventually in an inactive stage. Therefore, a myaesthenic patient even after doing some light work or exercise suffers from an unusual fatigue and feels as if he has become lifeless and dead.

Role of a chest gland in Myasthenia

The main reason of myasthenia is the enlargement in size of a gland, in side the chest called Thymus gland. This Thymus gland may be enlarged because of development of tumour inside the gland. This thymus gland is situated in the chest above the outer surface of the heart. In 90% cases of Myasthenia Gravis, Thymus gland is the main culprit and in only 10 % cases, autoimmune diseases are responsible for the disease.

How to suspect Myasthenia ?

In the initial stages of myasthenia disease, a myasthenic person feels difficulty in combing the hair. The patient gets exhausted very early, if asked to lift repeatedly even a lightweight object. He feels an excessive fatigue while climbing a few steps of a staircase or during a simple walking or slow running. Sometimes, patient of myasthenia develops difficulty in breathing even after a mild exercise or at rest.

Drunken eyes and emotionless face are striking features of Myasthenia

When the myasthenia progresses, drooping of one eyelid occurs. It becomes difficult to keep one or both eyes fully open for a long time. Both eyelids may droop permanently. Eyes look like ‘drunken eyes’ as eye closure is difficult. The patient loses the capacity to concentrate his eyes on a particular object. He might see two images of a same object. Face of a myasthenic patient becomes expressionless with no visible emotions. Lip may be protruded outside. When the patient suffering from myasthenia attempts to smile, it looks as if he is ‘snarling’. Lower jaw may droop down significantly.

Difficult drinking in myasthenia

While drinking, water may start coming out of patient’s nose. While eating, patient may feel suffocating sensation. Water or saliva may dribble from the angle of mouth. The patient of myasthenia may stammer while talking, and may feel a great difficulty, if asked to speak loudly. In majority of the patients, myasthenia starts with ‘drunken eyes’ where eyelids of either one eye or both may remain drooped down.

If asked to look straight, patient is unable to lift his eyelid. Even if, the patient is able to lift his eyelid, he cannot hold it for a minute, it will surely drop down. If a myaesthenic patient is requested to look skywards without lifting his head, his eyelids will automatically drop down within a minute.

Voice becomes a whisper in myasthenia

Myasthenic patient is unable to do counting loudly. His voice will turn slowly from a low- pitched one to almost a whisper. As the disease progresses, the face becomes listless and without any expression. Slowly weakness overtakes both upper and lower limbs. Myasthenic patients cannot keep his upper limbs out-stretched for a minute as in a classical school P. T. posture. In an advanced stage of myasthenia, patients are unable to swallow food properly and feel difficulty in breathing. This advanced stage of myasthenia is a life - threatening and may prove fatal, if not treated urgently. That is why it is imperative to start active treatment in its early stages.

Even a newly born is not immune to myasthenia

Even a newly- born infant of a myasthenic mother may develop signs of myasthenia, because culprit Ach.R. Antibodies may transfer from mother’s blood to infant’s blood. Breast-feeding becomes difficult as infants suffering from myasthenia are unable to swallow milk properly and may have episodes of breathlessness that may prove fatal. Infant’s cry an essential component of a normal health too gets diminished. Myasthenic babies cannot open their eyes properly.

Obstetrician doctor attending myasthenic pregnant women must take special care of these patients. They must be aware of the strong possibility of existence of myasthenia in the newly born infants in such cases. They must ensure that the delivery of such myasthenic pregnant ladies occur only in a large hospital fully equipped with neonatal intensive care unit, where full- time services of a team of Neonatologist are available.

Surgery has a vital role in treatment

The best and the most effective treatment of myasthenia gravis is surgery. During operation, the sole culprit thymus gland is removed completely from inside the patient’s chest. Surgery has four advantages. In significant number of myasthenic patients complete removal of thymus may lead to a complete cure of myasthenia. The second advantage of surgery is, that it helps controlling the symptoms and signs of myasthenia to a great extent and do not allow it to reach a life- threatening complicated stage. The third advantage of surgery is that the dose of medicines required after surgery becomes very minimum.

The fourth and the most important advantage of surgery is the early detection of thymic gland tumour, which in many cases turn out to be cancerous on postoperative biopsy examination. That is why now- a- days in western countries and in America, surgery has been accepted and established as a primary and first treatment of myasthenia. Every myasthenic patient must be offered the surgical option first.

When surgery is really not possible due to some other co-existent medical problems in patients, the medical treatment automatically becomes the no-other-way option in that situation. Medicines have their own side effects, which are harmful. For example, a drug called Prednisolone causes accumulation of salt and water inside the body resulting into a swollen face and body.

For myasthenia, many physicians in our country still continue to advice and give first preference to medical treatment instead of surgery. One must understand that medical treatment if started as a primary and first choice of treatment involves wastage of money as well as precious time because small thymic gland cancerous tumour if missed in its early stages, may cost the patient’s life later, where as at the same time surgery offers a safe and effective method for myasthenic patients.