Bay Biosciences provides high-quality, biopsy tissue samples. FFPE tissue blocks with matching fresh, frozen sera (serum), plasma, peripheral blood mononuclear cells (PBMC) bio-fluids from patients diagnosed with myasthenia gravis (MG) disease.
The sera (serum), plasma and PBMC biofluid specimens are processed from myasthenia gravis (MG) disease patient’s peripheral whole-blood using customized collection and processing protocols.
The biopsy tissue and matched biofluid samples are collected from unique patients diagnosed with myasthenia gravis (MG) disease and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluids are processed from myasthenia gravis (MG) disease patients peripheral whole-blood using customized collection and processing protocols.
Myasthenia Gravis (MG) Overview
Myasthenia gravis (MG) is a neuromuscular disease that causes weakness in the skeletal muscles, which are the muscles the body uses for movement.
The name myasthenia gravis, which is Latin and Greek in origin, means “grave, or serious, muscle weakness.”
It occurs when communication between nerve cells and muscles becomes impaired. This impairment prevents crucial muscle contractions from occurring, resulting in muscle weakness.
According to the Myasthenia Gravis Foundation Of America approximately 36,000 to 60,000 cases of myasthenia gravis are estimated in the United States. However, as myasthenia gravis often remains underdiagnosed, the prevalence of myasthenia gravis disease is most likely higher.
Myasthenia gravis (MG) is a rare long-term condition that causes muscle weakness. It most commonly affects the muscles that control the eyes and eyelids, facial expressions, chewing, swallowing and speaking.
But it can affect most parts of the body. Myasthenia gravis (MG) disease can occur regardless of race, gender and age. Myasthenia gravis typically starting in women under 40 and men over 60. Myasthenia gravis disease is not thought to be directly inherited nor contagious, but may occur in more than one member of the same family.
About 10 percent of patients with myasthenia gravis experience a potentially life-threatening complication in which these respiratory muscles weaken to the point that breathing is dangerously impaired, and the affected individual requires ventilation assistance.
This respiratory failure, called a myasthenic crisis, may be triggered by stresses such as infections or reactions to medications.
It is not transmitted via intimate or any form of human contact There is no known cure for myasthenia gravis, but there are many effective treatments available that can make managing life with myasthenia gravis easier.
Myasthenia gravis (MG) is treatable with drugs that suppress the immune system or boost the signals between nerve and muscle. Surgeries and other procedures are also helpful in many cases.
Most patients with the MG disease are able to manage their symptoms and lead active lives, and a few experience remissions lasting many years. In about 10% to 15% of cases, MG begins in childhood (juvenile onset), which tends to progress slowly and has a high incidence of remission.
Signs and Symptoms of Myasthenia Gravis (MG)
Major symptom of myasthenia gravis (MG) disease is weakness in the voluntary skeletal muscles, which are muscles under your control. The failure of muscles to contract normally occurs because they can’t respond to nerve impulses.
Without proper transmission of the impulse, the communication between nerve and muscle is blocked and weakness results. Weakness associated with myasthenia gravis (MG) disease typically gets worse with more activity and improves with rest.
The onset of the disorder may be sudden, and symptoms often are not immediately recognized as myasthenia gravis. The degree of muscle weakness involved in myasthenia gravis varies greatly among individuals.
Following are the common signs and symptoms of myasthenia gravis (MG) disease:
- A change in facial expression
- Drooping of one or both eyelids (ptosis)
- Difficulty speaking
- Difficulty swallowing
- Difficulty walking up stairs or lifting objects
- Blurred or double vision (diplopia)
- Facial paralysis
- Impaired speech (dysarthria)
- Trouble breathing due to muscle weakness
- Problems with chewing food
- Shortness of breath
- Fatigue
- Hoarseness in voice
- Weakness in the arms, hands, fingers, legs, and neck
Sometimes the severe weakness of myasthenia gravis may cause respiratory failure, which requires immediate emergency medical care.
Myasthenia Gravis (MG) Crisis
A myasthenic crisis is a medical emergency that occurs when the muscles that control breathing weaken to the point where individuals require a ventilator to help them breathe. It may be triggered by infection, stress, surgery, or an adverse reaction to medication.
According to national institute of neurological disorders and stroke, approximately 15 to 20 percent of patients with myasthenia gravis experience at least one myasthenic crisis. However, up to one-half of people may have no obvious cause for their myasthenic crisis.
Certain medications have been shown to cause myasthenia gravis. However, sometimes these medications may still be used if it is more important to treat an underlying condition.
Causes of Myasthenia Gravis (MG)
Myasthenia gravis disease is an autoimmune disease, which means it’s the result of the immune system (the body’s natural defense against infection) mistakenly attacking a healthy part of the body.
In Myasthenia gravis (MG) an error in the transmission of nerve impulses to muscles occurs. This results in interruption of normal communication between the nerve and muscle at the neuromuscular junction. This is the place where nerve cells connect with the muscles they control.
In an autoimmune condition, antibodies, which are proteins that normally attack foreign, harmful substances in the body, attack the neuromuscular junction.
Damage to the neuromuscular membrane reduces the effect of the neurotransmitter substance acetylcholine, which is a crucial substance for communication between nerve cells and muscles. This results in muscle weakness.
Myasthenia gravis is caused by a problem with the signals sent between the nerves and the muscles. In myasthenia gravis, the immune system damages the communication system between the nerves and muscles, making the muscles weak and easily tired.
It’s not clear why this happens, but it’s been linked to issues with the thymus gland (a gland in the chest that’s part of the immune system). Most patients with myasthenia gravis disease have a thymus gland that’s larger than normal. Around one in ten people have an abnormal growth of the thymus called a thymoma.
Diagnosis of Myasthenia Gravis (MG)
Myasthenia gravis patients need to go through complete physical exam, as well as a detailed history of the symptoms are discussed with the physician.
Patients also go through a neurological exam to confirm the diagnosis of myasthenia gravis and rule out other similar conditions. This may consist of:
- Checking for muscle tone
- Looking for muscle weakness
- Checking the reflexes
- Making sure that the eyes move properly
- Sensation test in different areas of the body
- Testing motor functions, like touching your finger to your nose
Other tests that can help the doctor diagnose myasthenia gravis disease include:
- Blood tests for antibodies associated with MG
- Repetitive nerve stimulation test
- Edrophonium (Tensilon) test
- MRI and CT scans to rule out a tumor.
Following are several tests performed to confirm the diagnosis of myasthenia gravis:
- A Physical and Neurological Exam: A physician will first review an individual’s medical history and conduct a physical examination. In a neurological examination, the physician will check muscle strength and tone, coordination, sense of touch, and look for impairment of eye movements.
- An Edrophonium Test: This test uses injections of edrophonium chloride to briefly relieve weakness in patients with myasthenia gravis (MG). The drug blocks the breakdown of acetylcholine and temporarily increases the levels of acetylcholine at the neuromuscular junction. It is usually used to test ocular muscle weakness.
- Blood Tests: Most patients with myasthenia gravis have abnormally elevated levels of acetylcholine receptor antibodies.A second antibody called the anti-MuSK antibody, has been found in about half of individuals with myasthenia gravis who do not have acetylcholine receptor antibodies. A blood test can also detect this antibody. However, in some patients with myasthenia gravis (MG), neither of these antibodies is present. These individuals are said to have seronegative (negative antibody) myasthenia.
- Electro-Diagnostics: Diagnostic tests include repetitive nerve stimulation, which repeatedly stimulates a patient’s nerves with small pulses of electricity to tire specific muscles. Muscle fibers in myasthenia gravis, as well as other neuromuscular disorders, do not respond as well to repeated electrical stimulation compared to muscles from normal individuals. Single fiber electromyography (EMG), considered the most sensitive test for myasthenia gravis, detects impaired nerve-to-muscle transmission. EMG can be very helpful in diagnosing mild cases of myasthenia gravis when other tests fail to demonstrate abnormalities.
- Diagnostic Imaging: Diagnostic imaging of the chest using computed tomography (CT) or magnetic resonance imaging (MRI) may identify the presence of a thymoma.
- Pulmonary Function Test: Measuring breathing strength can help predict if respiration may fail and lead to a myasthenic crisis.
Because weakness is a common symptom of many other disorders, the diagnosis of myasthenia gravis is often missed or delayed (sometimes up to two years) in patients who experience mild weakness or in those individuals whose weakness is restricted to only a few muscles.
Treatment of Myasthenia Gravis (MG)
The main goal of myasthenia gravis (MG) treatment is to manage the symptoms and control the activity of the immune system, since there is no cure for myasthenia gravis disease.
Medications
Corticosteroids and immunosuppressants are used to suppress the immune system. These medications help minimize the abnormal immune response that occurs in myasthenia gravis (MG) disease.
Additionally, cholinesterase inhibitors, such as pyridostigmine (Mestinon), can be used to increase communication between nerves and muscles.
Thymus gland removal
Removal of the thymus gland, which is part of the immune system, may be appropriate for many myasthenia gravis (MG) patients. After the thymus gland is removed, myasthenia gravis (MG) patients typically show less muscle weakness.
According to the Myasthenia Gravis Foundation of America, between ten to fifteen percent of myasthenia gravis (MG) patients will have a tumor in their thymus. Tumors, even those that are benign, are always removed because they may become cancerous.
Plasma exchange
Plasma exchange is also known as plasmapheresis. This process removes harmful antibodies from the blood, which may result in an improvement in muscle strength.
Plasmapheresis is a short-term treatment. The body continues to produce the harmful antibodies and weakness may recur. Plasma exchange is helpful before surgery or during times of extreme myasthenia gravis (MG) weakness.
Intravenous immune globulin
Intravenous immune globulin (IVIG) is blood product that comes from donors. It’s used to treat autoimmune myasthenia gravis (MG) disease. Although it’s not entirely known how IVIG works, it affects the creation and function of antibodies.
Lifestyle changes
There are some things you can do at home to help alleviate symptoms of myasthenia gravis (MG):
- Get plenty of rest to help minimize muscle weakness.
- If you’re bothered by double vision, talk to your doctor about whether you should wear an eye patch.
- Avoid stress and heat exposure, as both can worsen the symptoms.
These treatments cannot cure myasthenia gravis (MG) disease. However, you’ll typically see improvements in your symptoms. Some individuals may go into remission, during which treatment is not necessary.
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