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24 | James Hubbard's My Family Doctor | The Magazine That Makes Housecalls Q housecalls neurology I would like to know the most recent info. you have concerning myasthenia gravis, as our older sister has had this disease since I was 15. How does this disease affect a person as they become older? She has had her thymus gland removed. This is a strange disease of which few specialists are available. The neuro docs don't really like to deal with it much. Also, I know one woman who was diagnosed with this disease at 75. Amazing it strikes at that older age when my sister was 18. —belinda, MississiPPi AnSWER Prior to 1950, this auto- immune disease was often fatal. What a difference a few decades make. To- day, most people are diagnosed early and treatment is typically effective. Since only one in 10,000 people has myasthenia gravis, I can under- stand why your sister has had trouble finding doctors who specialize in it. I will try to shed some light. Myasthe- nia gravis, in fact, represents one of the best-understood and most treat- able conditions in neurology. WHEn AnTIBODIES ATTACK Myasthenia gravis is an immune-sys- tem disorder that causes fluctuating weakness. Normally, your body produces antibodies that help get rid of bad Weak Muscles and Your Immune System By RoBERT M. PaSCUzzi, M.D. guys like bacteria and viruses. With myasthenia gravis, the antibodies get confused and attack muscles, interfer- ing with your nerves' ability to com- municate with them. We don't know why this happens. Initial symptoms are often droopy eyelids and double vision. Many people eventually experience slurred speech, trouble chewing and swallowing, and variable degrees of arm and leg weakness. The symp- toms can be mild or life-threatening, especially if it severely affects your breathing and swallowing muscles. As you mentioned, this disease can strike anyone from children to the elderly. Commonly, women get it in their 20s or 30s, and men get it in their 50s or 60s. Symptoms come and go. You may have periods when you're relatively normal and periods of significant weakness. Sometimes, an infection or a new medication can trigger a flare-up. AGE IS GOOD People usually do better and bet- ter over many years. If you've been stable for a decade or so, you have an excellent chance of remaining that way. Fortunately, myasthenia gravis is treatable. Most people improve with medicines called cholinesterase in- hibitors, such as pyridostigmine (Mes- tinon). These help the muscles get the nerve signals. For many people with more severe disease, drugs that suppress the immune system are ef- fective. These include prednisone and azathioprine (Azasan, Imuran). As you might imagine, taking such drugs comes with some precautions your doctor will tell you about. Some people require plasma ex- change, in which they get the damag- ing antibodies literally washed out of the bloodstream. Adminis- tering normal antibod- ies called gamma globulin has proven to be a valuable treatment strategy. And there has been longstanding interest in the role of thymus-gland removal since the thymus is con- nected with the immune system. You can do without it because after the first few years of life, it's no longer necessary for normal immune-system function. The point is, multiple effective forms of treatment are available, and most people should expect to do pretty well over the long-term. Board-certified neurologist RobeRt M. Pascuzzi, M.d., is a professor and chair of neurology at Indiana University School of Medicine and a neurologist with Clarian Neu- roscience, which offers neurological services at three hospitals in Indiana. He's also chairman of The American Board of Psychiatry and Neurology and past-chair of the Myasthenia Gravis Foundation of America's Medical and Scientific Advisory Board. FoR MoRE INFo Myasthenia Gravis foundation of america www.myasthenia.org (800) 541-5454