Diana earned her PhD and PharmD with distinction in the field of Medicinal and Pharmaceutical Chemistry at the Universidade do Porto. She is an accomplished oncology scientist with 10+ years of experience in developing and managing R&D projects and research staff directed to the development of small proteins fit for medical use.
Myasthenia gravis (MG) is a rare autoimmune disease that affects the neuromuscular junctions of the skeletal muscles.1,2 The production of autoantibodies directed against postsynaptic membrane proteins causes disturbances in the electrical signals traveling between nerves and muscles.2 The hallmark of this disorder is weakness and fatigue of the muscles of the eyes, throat, and limbs. Patients who develop myasthenic crisis also experience weakness in the respiratory muscles, which may lead to respiratory paralysis.1,2
Care Team in Myasthenia Gravis
The management of MG relies on a multidisciplinary healthcare team, which includes specialists such as neurologists and neuromuscular specialists, ophthalmologists, rheumatologists, thoracic surgeons, psychologists, nutritionists, and physical, occupational and speech therapists. A primary care doctor can also help MG patients manage their overall health,3 as well as efficiently educate patients on triggering events, possible complications, and available treatments.2
The Myasthenia Gravis Foundation of America provides a network of MG healthcare providers around the United States. It also provides an application, myMG, that allows patients to track how are they managing multiple aspects of their disease and further promotes discussion between the patient and their care team.3
Neurologists and Neuromuscular Specialists
A neurologist specializes in the diagnosis, treatment, and management of disorders of the brain and nervous system.4 Confirmation of an MG diagnosis requires a physical and neurological examination to assess muscle strength and tone, coordination and balance, changes in sense of touch, and dysfunction of ocular motility.5,6
A neuromuscular specialist provides care to patients with neuromuscular diseases. The articulation of these specialists with physical, occupational, and speech therapists is important to maximize patients’ functional capabilities.7
About 85% of patients with MG will present with weakness affecting the muscles of the eye. Patients may experience diplopia and/or ptosis.2 An ophthalmologist is responsible for visual function and eye care.8 Patients with MG should also be followed by neuro-ophthalmologists who specialize in vision problems related to interactions between the eyes and the brain, nerves, and muscles. They also diagnose and treat optic nerve problems including vision loss, eyelid abnormalities, double vision, abnormal eye movements, and unequal pupil size. They also treat diseases which cause problems like multiple sclerosis, brain tumor, strokes, and thyroid eye disease.9
Rheumatologists specialize in the diagnosis and treatment of diseases of the muscles and joints as well as systemic autoimmune diseases.10 As an autoimmune disease that affects different muscles, MG care teams and patients will benefit from the experience of these specialists.
Patients with MG may require thymectomy to remove the thymus, as this gland can be involved in the development of the disease.1 A thoracic surgeon specializes in operating on organs inside the chest and therefore can benefit the MG medical team.11
Physical and Occupational Therapists
Patients with MG must perform controlled exercise to avoid overexertion, which could exacerbate symptoms. Physical therapy is recommended to help patients with MG maintain muscle strength and range of motion.1 Physical therapists are specialists who improve the quality of life of patients through prescribed exercise and patient education.12
Patients with MG can also benefit from the care of an occupational therapist. These specialists can help patients navigate their daily activities while preventing injury and cope with physical changes that develop over the course of the disease.13
Patients with MG often experience difficulties in swallowing (dysphagia) and speaking (dysarthria) due to weakness in the muscles of the throat, face, and jaw.1 Specialists in speech and language disorders who can treat communication, or with eating, drinking, and swallowing issues will help MG patients work through these difficulties. These specialists can also work closely with occupational therapists.14
Living with MG often requires patients to adapt their diet as challenges in eating and drinking arise. Patients must also choose a healthy diet that provides them with all the required nutrients each day. A nutritionist can help not only in preparing a proper nutritional plan, but also in further evaluating eating problems that develop over time.15
Living with a chronic disease is often a source of stress in patients. Limitations in their physical functioning may lead patients with MG into different psychological states, including depression.16 Integrating psychologists into the MG care team offers support to patients in coping with the feelings and emotions experienced over the course of the disease.17
1. Myasthenia gravis. National Organization for Rare Disorders (NORD). Accessed February 15, 2022.
2. Beloor Suresh A, Asuncion RMD. Myasthenia gravis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. Accessed February 15, 2022.
3. Your healthcare. Myasthenia Gravis Foundation of America. Accessed February 15, 2022.
4. What is a neurologist? American Academy of Neurology. Accessed February 15, 2022.
5. Myasthenia gravis fact sheet. National Institute of Neurological Disorders and Stroke. Accessed February 15, 2022.
6. Evoli A, Iorio R. Controversies in ocular myasthenia gravis. Front Neurol. 2020;11:605902. doi:10.3389/fneur.2020.605902
7. McDonald CM, Fowler WM Jr. The role of the neuromuscular medicine and physiatry specialists in the multidisciplinary management of neuromuscular disease. Phys Med Rehabil Clin N Am. 2012;23(3):475-493. doi:10.1016/j.pmr.2012.06.010
8. Churchill J, Gudgel DT. What is an ophthalmologist? American Academy of Ophthalmology. January 11, 2022. Accessed February 15, 2022.
9. Boyd K. Ophthalmology subspecialists. American Academy of Ophthalmology. June 6, 2016. Accessed February 15, 2022.
10. What is a rheumatologist? American College of Rheumatology. Updated May 2021. Accessed February 15, 2022.
11. Thoracic surgeon. National Cancer Institute. Accessed February 15, 2022.
12. What physical therapists do. American Physical Therapy Association. Accessed February 15, 2022.
13. About occupational therapy. American Occupational Therapy Association. Accessed February 15, 2022.
14. What is speech and language therapy? Royal College of Speech & Language Therapists. Accessed February 15, 2022.
15. Wellness strategies. Myasthenia Gravis Foundation of America. Accessed February 15, 2022.
16. Jeong A, Min JH, Kang YK, et al. Factors associated with quality of life of people with myasthenia gravis. PLoS One. 2018;13(11):e0206754. doi:10.1371/journal.pone.0206754
17. What do practicing psychologists do? American Psychological Association. December 11, 2019. Accessed February 15, 2022.
Reviewed by Debjyoti Talukdar, MD, on 2/17/2022.