Multiple sclerosis presents patients with a number of symptoms that can disrupt everyday life. During an episode for those with relapsing-remitting MS, or those with one of the progressive MS forms with constant symptoms, obtaining a diagnosis that allows the patient to work with doctors and therapists to create a treatment and management regimen is crucial to living a full and healthy life.
Of course, MS is not the only chronic disease that causes such issues or requires direct attention. Another condition, called Myasthenia gravis, can also cause significant impairment when trying to complete daily activities. In fact, Myasthenia gravis actually seems quite similar to some aspects of multiple sclerosis and distinguishing one from the other is essential to prescribing the right treatment plan.
What is myasthenia gravis?
Myasthenia gravis is an autoimmune condition distinguished by the fast-weakening and fatigue of voluntary muscles and muscle groups. In most cases, this happens when the immune system produces a specific antibody that interferes with the communication between nerves and muscles. Muscles are equipped with receptors into which neurotransmitters fit and send signals for functionality. These antibodies block the transmitters and sometimes destroy the receptors, leaving fewer lines of communication between the brain and muscle, which leads to weakness. These antibodies also seem to block the function of the protein which builds these junctions.
It’s believed that these antibodies are formed in the thymus gland, which may have a tumor (in about fifteen percent of patients with Myasthenia gravis) or could be oversized (should be small in adults). The biggest confusion is that, in some patients, the disease is not caused by antibodies, and there is no known reason for the problem.
Myasthenia gravis and multiple sclerosis: symptoms and similarities
As a condition of the nervous system, there are obviously going to be similarities in the presentation of Myasthenia gravis and multiple sclerosis. Some of these include:
- Both diseases are chronic autoimmune diseases that lead to improper or lack of communication between the brain (at the head of the central nervous system) and muscles, which makes mobility more difficult.
- Both conditions cause weakness in the limbs, as well as potential issues with vision (especially double vision or blurred vision).
- Though the reason behind the deficiency is different, either disease can lead to problems speaking, chewing, and swallowing (caused by weakness in Myasthenia gravis and nerve damage in multiple sclerosis).
- Both diseases are most common in adult women under the age of forty.
- Having another autoimmune disease, such as rheumatoid arthritis or type 1 diabetes, puts a person at greater risk for developing either disease.
- Both diseases may “come and go”, with relief from symptoms over a period of time before they return.
- A relapse or episode in either disease can be triggered by factors such as stress, fatigue, illness or injury, and certain medications (beta blockers, for example).
- Neither disease has a cure, but both can be treated to reduce relapses and symptoms. Some common treatments for both include immunosuppressants, corticosteroids, and DMTs (disease modifying therapies) like treatment with monoclonal antibodies.
Myasthenia gravis and multiple sclerosis: Conditions and differences
One of the biggest differences between multiple sclerosis and Myasthenia gravis is that the latter is far less common than MS. While multiple sclerosis is believed to affect about one in four hundred people, Myasthenia gravis is estimated to develop in only about one in five thousand. Other differences include:
- While MS attacks the central nervous system (CNS) and depletes the protective myelin coating and exposes the nerves to damage, Myasthenia gravis causes communication issues in the peripheral nervous system, with its effects seen at the connection sites on the muscles that receive signals.
- Both diseases tend to see relapse and remission periods. However, until MS advances to the secondary progressive stage, symptoms don’t usually worsen. With Myasthenia gravis, it’s common for returning symptoms to worsen with each flare up.
- Myasthenia gravis can be treated with a plasma filtering process that removes the offending antibodies from the blood stream, reducing the effects and progression of the disease. This isn’t a method that can be employed for multiple sclerosis.
- While rest can help reduce exacerbated symptoms of MS, it doesn’t always help to end a relapse. Typically, in Myasthenia gravis, a flare up of symptoms can be significantly reduced with extensive rest.
- Though both conditions require extensive testing to make a diagnosis, the battery of tests is very different. In MS, doctors will typically request blood tests, an MRI, a spinal tap, and an evoked potential (EP) test. To diagnose Myasthenia gravis, the list is far longer:
- Neurological examination
- Edrophonium injection test (usually results in a very sudden and temporary increase in muscle strength for patients with Myasthenia Gravis)
- Ice pack test (to see if an ice pack improves droopy eyelids)
- Blood tests
- Repetitive nerve stimulation with electrodes
- Single fiber EMG
- MRI or CT scans
- Pulmonary function tests
In addition, while both diseases involve weakness in the limbs, this is typically one of the first signs of multiple sclerosis. In Myasthenia gravis, it usually only follows weakness in the neck, facial muscles, and eyes.
Both Myasthenia gravis and multiple sclerosis are extremely likely to inhibit a normal, independent lifestyle if left undiagnosed and untreated. In fact, a patient may not know the difference between the two and have increased stress and anxiety should they not consult with a physician about symptoms to determine the exact cause of their symptoms, which will only exacerbate the problem.
With new treatment options available all the time through significant research into both diseases, as well as alternative therapies and supplements that can be used to aid in managing symptoms, the prognosis for people with either disease is much better than it was even a decade ago. However, it’s essential to know what’s wrong so that treatment and therapy can be prescribed as needed. The right regimen can reduce flare ups and postpone the advancement of either progressive neurological disease, assisting with greater functionality and a more full and happy life.