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Dr. Roach: Autoimmune disease targets connection of nerves and muscle

Keith Roach
To Your Health

Dear Dr. Roach: What can you tell me about myasthenia gravis? My dear friend was diagnosed with it and hospitalized for eight days. She is able to walk and move about, but now, six weeks later, she is still on a liquid diet and unable to move any of her facial muscles.

— I.M.

Dear I.M.: Myasthenia gravis, from the Latin and Greek for “serious muscle weakness,” is an autoimmune disease that attacks the connection of nerves to muscles. Specifically, the body attacks the acetylcholine receptor or its associated proteins, where nerves connect to skeletal muscles. This causes weakness of the muscles and increased susceptibility to fatigue.

The diagnosis of MG is suggested by typical symptoms, the most common of which are eye symptoms like double vision or droopy eyelid (ptosis). A smaller number of people will have symptoms that involve eating and chewing — this sounds like your friend’s primary problem — and a few will have weakness in the limbs, neck or face, or of the breathing muscles. The diagnosis is usually confirmed by blood testing, but a few people will need more sophisticated testing, such as an electrical muscle stimulation test.

MG commonly affects women under 40 and men over 60, but it can occur in any age group. The thymus, an immune organ that is located in the upper chest behind the sternum (breastbone), is an important origination point for MG, and 10-15% of people with MG have tumors of the thymus. Surgical removal of the thymus is often performed to improve symptoms.

In addition to removal of the thymus, there are three other types of treatment for MG. The first is medicines that help the nerve-muscle receptor work better, such as pyridostigmine. This starts working within minutes. The second is treatments to get rid of the antibodies attacking the receptor. Plasmapheresis, the physical removal of antibodies, takes a few days to start working; intravenous immune globulin takes a week or two to work. It’s not clear exactly how these work in MG. The third type, anti-immune system drugs, take much longer: a few weeks for prednisone but several months at least for others, such as cyclosporine and mycophenolate.

Your friend is in a period where many of the treatments have not had time to work yet, and I expect that she will get better as the treatments take hold. Her doctors may be talking to her about removing the thymus, but she needs to be well controlled before surgery. Some experts use plasmapheresis or immune globulin to get good control quickly before surgery, especially in people whose symptoms involve eating and facial functions.

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Dear Dr. Roach: My 57-year-old son has been diagnosed with stage 1 pancreatic cancer. He has chosen not to have surgery, nor take chemotherapy or radiation. He has his own personal reasons and I respect that. Do you know of any other treatments, such as diet?

— Anon.

Dear Anon.: Every person has the right to seek or refuse treatment. However, stage 1 pancreatic cancer is potentially curable with surgery, and time is of the essence. Many people have changed their minds about seeking standard treatment only after alternative treatment fails and their disease progresses. While I understand your respect for his decision, it is hard for an outsider like me to see someone refuse potentially curative treatment for a disease that will shortly become incurable in all likelihood. Hopefully his decision was made based on a thorough and careful review of the facts.

While a healthy diet, herbs, massage and other therapies may be helpful in making people feel better, there is no good evidence that they will cure this terrible disease.

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