Myasthenia Gravis

Myasthenia gravis symptoms often start gradually and can be mistaken for signs of other health conditions. Your arms and legs might be weak. You could be really tired, have droopy eyelids, double vision, slurred speech, problems with swallowing and chewing and shortness of breath. MG attacks often come and go.

While many MG cases have no known cause, others can be linked to problems in the thymus gland, a small organ in the upper chest. The thymus is part of the lymphatic system and makes white blood cells that fight infection. Some people have an overactive thymus. Others may have a tumor called a thymoma.

All of these factors can make diagnosing myasthenia gravis tricky. That’s why it’s important to work with healthcare providers who are familiar with recognizing and treating myasthenia gravis. At Cleveland Clinic, we have a dedicated healthcare team with in-depth knowledge of MG. They can diagnose it quickly and correctly so you can move forward with personalized treatment.

What to expect at your first visit

At your appointment, your providers will go over your health history. Then they’ll want to know about your symptoms — when they started, how long you’ve had them, how they make you feel and what seems to trigger them. You’ll also have a physical exam and do testing to help pinpoint what’s going on. It’s important to make your prior medical records available so that our providers can review them with you.

Myasthenia gravis testing

There are a number of tests we can do to figure out if you have MG. You may have one, some or all of these:

• Ice pack test: This test can help us find out if your drooping eyelids are caused by myasthenia gravis. The drooping will get better if we put ice packs on your eyes.
• Imaging tests: CT scans and MRIs let us take detailed pictures of your insides so we can get a better look at what’s going on with your body. These imaging tests are often needed to check your thymus gland and rule out other disorders in your brain or spine.
• Antibody tests: These tests let us see if you have antibodies in your blood that can keep your nerves and muscles working together the right way.
• Electromyogram (EMG): This test measures the electrical activity of your muscles and nerves to see if they have trouble communicating. We offer a specialized test called single fiber electromyography, if needed.

Meet Our Myasthenia Gravis Team

Your Cleveland Clinic care team will include healthcare providers from different specialties — all chosen based on your symptoms and needs. Your care team works together to confirm that you have MG and create a treatment plan that keeps you and your unique diagnosis at the center of everything.

Your team may include:

• Neurologists.
• Neuro-ophthalmologists.
• Thoracic (chest) surgeons.
• Radiologists.
• Physical therapists.
• Occupational therapists.

With the right treatment, there’s a good chance you’ll be able to get back to doing the things you love. That’s why we make sure your care is as unique as you are. We pay close attention to your symptoms and test results when crafting your treatment plan. Your plan could include a mix of medications, rehabilitation therapy, or in some cases, surgery. Our ongoing research into MG means we may be able to offer you new therapies before they’re widely available.

Medications

We often start treatment with medications to help manage and improve your symptoms. These can include:

• Cholinesterase inhibitors, like pyridostigmine (Mestinon® or Regonol®) that help with mild forms of MG. They prevent acetylcholine (a chemical that carries messages from your brain to your body through your nerve cells) from breaking down to help your muscles move.
• Corticosteroids, like Prednisone®, can keep your immune system from attacking your body by limiting how many antibodies it makes.
• Immunosuppressants can stop your immune system from targeting healthy cells and tissues and keep MG flares at bay.

Immunoglobulin

We’ll give you healthy antibodies (immunoglobulins) taken from donor blood through a vein in your arm (intravenously). Or we may choose to inject immunoglobulin through your skin so it absorbs slower (subcutaneous immunoglobulin or SCIG).

Plasma exchange (plasmapheresis)

During a plasma exchange treatment, we’ll take harmful antibodies out of your bloodstream by replacing your plasma with some from a healthy donor. We use a machine that separates plasma from blood and then returns it to your body.

Monoclonal antibodies

We’ll use lab-created antibodies to reduce the number of immune cells that make the damaging antibodies. Rituximab (Rituxan®, Ruxience®, Riabni™) is one antibody that can help suppress an overactive immune system.

Efgartigimod Alfa

Efgartigimod Alfa is a medication that’s injected into your vein. It reduces the amount of antibodies you have in your blood that can cause muscle weakness.

Eculizumab and Ravulizumab

Eculizumab and Ravulizumab are also medications injected into your vein. If your immune system is working overtime and triggering MG attacks, these medications can slow it down. We may recommend these medications if you have severe symptoms or standard therapies aren’t working.

Physical therapy

You may have physical therapy to relieve your fatigue and help you feel stronger. Our rehabilitation experts will work with you to develop a personalized plan that focuses on gentle, low-intensity exercise.

Surgery

Sometimes, the thymus gland plays a part in your myasthenia gravis diagnosis. If so, we might recommend you have surgery to remove it (thymectomy). Sometimes surgery can improve MG symptoms even if you don’t have a tumor.

Taking the Next Step

Having myasthenia gravis shouldn’t keep you from living a productive and active life. Cleveland Clinic’s experienced team of healthcare providers specialize in treating MG with personalized care to help you manage symptoms and have fewer attacks. We want to improve your quality of life so you can confidently do the things you love.