What is myasthenia gravis?
Myasthenia Gravis is a chronic neuromuscular disease characterized by muscle weakness of the voluntary muscles. The weakness is due to a breakdown in the neuromuscular junction or the communication between a nerve ending and its adjoining muscle fibers.
Symptoms of myasthenia gravis may include droopy eyelid, double vision, slurred speech, swallowing and chewing difficulty, shortness of breath, and arm or leg weakness. Symptoms can be variable among patients or on the same individual. The onset of myasthenia gravis can be sudden, with severe and generalized muscle weakness, but more commonly, symptoms in the early MG stage are subtle and variable, making it difficult to achieve a diagnosis correctly and quickly.
Why choose Cleveland Clinic?
Cleveland Clinic’s Myasthenia Gravis Program has expertise in the diagnosis, treatment and research of myasthenia gravis and other neuromuscular junctional disorders such as Lambert-Eaton myasthenic syndrome and congenital myasthenic syndrome.
Specialists in Cleveland Clinic’s Neuromuscular Center offer comprehensive care to achieve an accurate diagnosis of neuromuscular junction disorder and rely upon state-of-the-art treatment methods to optimize quality of life. Our multidisciplinary team includes neuromuscular specialists, neuro-ophthalmologists, thoracic surgeons and rehabilitation specialists.
Recognized by the Myasthenia Gravis Foundation of America, our program provides care for more than 1,000 patients with myasthenia gravis, offering high –quality comprehensive evaluations and treatment modalities including the use of intravenous immunoglobulin (IVIG), plasmapheresis or plasma exchange, rituximab, eculizumab and other cutting-edge treatment options for myasthenia gravis.
What We Treat
Diseases & Conditions
- Congenital myasthenic syndrome
- Lambert-Eaton myasthenic syndrome
- Myasthenia gravis
Diagnostics & Testing
- Blood Test
- Computed Tomography (CT) Scan
- Edrophonium (Tensilon) test
- Electromyogram (EMG)
- Magnetic Resonance Imaging (MRI)
- Ice pack test
- Repetitive nerve stimulation (RNS)
- Single fiber electromyography (SFEMG)
Treatments & Surgery Options
- Cholinesterase inhibitors such as pyridostigmine (mestinon)
- Corticosteroids such as prednisone
- Mycophenolate Mofetil
- Intravenous immunoglobulin (IVIg)
- Subacutaneous immunoglobulin (SCIG)
What to Expect
Patients seen in the Myasthenia Gravis Program are assessed by a team of experts who develop an individualized treatment plan based on history, examination and test results.
How is Myasthenia Gravis Diagnosed?
Physicians will obtain a detailed history and perform a thorough physical exam, looking for muscle weakness or fatigue.
Tests to help confirm a diagnosis of myasthenia gravis might include:
- Blood test may be ordered to measure the presence of acetylcholine receptor antibodies or other antibodies.
- Computed Tomography (CT) Scan is used to produce 3D images of a cross-section of the body with X-rays and computers, with a focus on the chest region.
- Magnetic Resonance Imaging (MRI) is a radiologic technique that uses harmless magnetic waves (rather than X-rays) to produce images. At times, it can be an alternative method to CT scan.
- Edrophonium (Tensilon) test: Edrophonium is a drug that blocks the breakdown of acetylcholine, helping the neurotransmitter activate the muscle. An intravenous form is given and physician will evaluate for improvement to determine the neuromuscular junction functional status.
- Ice pack test is simple and easily performed on a droopy eyelid, often helping to confirm a myasthenia gravis diagnosis by analyzing the eyelid for signs of improvement.
- Electromyogram (EMG) is a procedure that assess the nerve and muscle function electrically.
- Single fiber electromyography (SFEMG) is a specialized EMG procedure that assesses nerve and muscle function electrically. A sterile needle is inserted into the muscle to test the stability of electrical transmissions between single muscle fibers.
How is Myasthenia Gravis Treated?
If diagnosed promptly, most patients improve by removal of the thymus gland (thymectomy) or treatment of cholinesterase inhibitors and/or immunosuppressants. The effectiveness of treating myasthenia gravis depends on many factors, such as the severity of the disease, the duration of the disease, the patient’s age and overall health, and the familiarity of treating physicians. Our physicians work in a multidisciplinary team to achieve complete remission or minimal symptomatic manifestation for patients with myasthenia gravis.
Treatment options for myasthenia gravis may include:
- Cholinesterase inhibitors (such as pyridostigmine) are commonly used drugs to treat myasthenia gravis, but they are more useful in mild forms of the condition. These drugs work by preventing the breakdown of acetylcholine, thus increasing the muscle’s ability to contract.
- Corticosteroids are commonly referred to as steroids, are a type of anti-inflammatory drugs that inhibit the immune system, limiting antibody production. Prednisone is the most commonly used type of steroids to treat myasthenia gravis.
- Other immunosuppressants are commonly used to treat myasthenia gravis. They include azathioprine, mycophenolate mofetil, cyclosporine, methotrexate, or tacrolimus.
- Eculizumabis an antibody that blocks part of the immune system called complement activation, which plays a vital role in damaging the neuromuscular junction.
- Intravenous immunoglobulin (IVIg) is an infusion that may alter the immune response by replacing the damaging antibodies with antibodies pooled from healthy donor blood.
- Subcutaneous immunoglobulin (SCIG) is an injected through the skin to allow a slower absorption.
- Plasmapheresis is a blood plasma exchange process. It filers the blood of antibodies by replacing the patient’s plasma with donor plasma or albumin.
- Rituximab is a monoclonal antibody that works to reduce the number of B lymphocyte cells, the type of immune cells that produce the damaging antibodies.
In some people with myasthenia gravis, surgery may be recommended to remove the thymus gland. This has been shown to improve myasthenia gravis symptoms in patients with positive antibodies to acetylcholine receptor.
- Thymectomy is a surgical removal of the thymus gland, which is located under the breast bone. This surgical procedure is commonly performed in patients who develop a slow-growing tumor in the thymus, called thymoma. This type of tumor occurs in a small percentage of myasthenia gravis patients but the procedure can also be very beneficial in the treatment of myasthenia gravis for patients who do not have thymoma.
Researches on Myasthenia Gravis at Cleveland Clinic
The Neuromuscular Center at Cleveland Clinic has been active in participating in interventional and non-interventional trials on myasthenia gravis. If you are interested in participating in our research studies, talk to a neuromuscular specialist during your next visit or contact us by email at NeuromuscularResearch@ccf.org or call 216.704.1250.
Benjamin Claytor, MD
Joshua Gordon, MD
Kerry Levin, MD
Yuebing Li, MD, PhD - Program’s Lead Physician
Mei Lu, MD, PhD
Rebecca Kuenzler, MD
Robert Marquardt, DO
John Morren, MD
Eric Pioro, MD, PhD
David Polston, MD
Robert Shields, MD
Steven Shook, MD
Nimish Thakore, MD
Pedro Torrico, MD
Jennifer Ui, MD
Physical Medicine and Rehabilitation Specialist
Appointments & Locations
Make an Appointment
To make an appointment with a myasthenia gravis specialist in Cleveland Clinic’s Neuromuscular Center, please call 216.636.5860 or 866.588.2264.
Whether you're a new or existing patient, you can get an initial evaluation or follow-up care from a neuromuscular specialist using your phone, tablet or computer. This means there's no travel or parking, less waiting and significant time savings. Call 216.636.5860 to schedule a virtual visit for you or a loved one and get details on cost and set-up instructions.
MyChart connects you to your health care team from the comfort and safety of home. With this secure, online tool you can manage your appointments and complete pre-visit tasks, communicate with your providers, and keep track of your test results and medications.
Refer a Patient
The Neuromuscular Center offers direct referral lines to ease the process of making a patient referral.
To refer a patient to the Neurological Institute via phone, please call our dedicated physician referral hotline at 216.445.8455. An intake coordinator will handle your call directly. If you are unable to reach an intake coordinator, please leave a message and they will return your call within the work day (if left before 1 p.m. ET) or the next work day (if left after 1 p.m. ET).
To refer a patient to the Neurological Institute via fax, please download and complete our physician referral form and fax to 216.636.2596.
Stay connected to patients you refer to Cleveland Clinic through online updates and electronic medical records.