Diagnosing the Symptoms of Generalized Myasthenia Gravis (gMG)

Dr. Tahseen Mozaffar discusses the symptoms of generalized myasthenia gravis (gMG), diagnostic challenges, prognosis, and new therapeutic options for managing gMG. Learn more at www.myasthenia.org  

Dr. Tahseen Mozaffar, Vice Chair for Education and Professor, Department of Neurology, University of California, Irvine School of Medicine; Director, ALS and Neuromuscular Center, UC Irvine.


Neal Howard: Welcome to Health Professional Radio. I’m your host, Neal Howard. Glad that you could join us once again. In our ongoing series this month, June being Generalized Myasthenia Gravis Awareness Month, we are joined this afternoon with Dr. Tahseen Mozaffar, Vice Chair of Education and Professor Department of Neurology at the University of California joining us today to further educate us about this rare neuromuscular disease. Welcome to the program, Dr. Mozaffar. How are you?

Dr. Tahseen Mozaffar: I’m fine. Thank you so much for having me online.

N: Well, I mentioned that you are Vice Chair of Education and Professor Department of Neurology at the University of California. Give our listeners just a bit more background about yourself if you would.

T: Sure. I’m a neurologist by training. I specialize in neuromuscular diseases and I run the Neuromuscular Program at the University of California, Irvine and I’m also the Interim Chair of the Department of Neurology. So I manage the entire Department of Neurology which is about 51 physicians. And as part of this, I just want to mention that we have a large practice in neuromuscular diseases and we have a large clinic with patients with myasthenia gravis.

N: So the typical myasthenia gravis patient, are they male, female, young, old? What is the typical patient that you see that’s dealing with MG?

T: Sure. Myasthenia Gravis can occur at any age. Typically the highest incidence is in the younger folks between the ages of 18 and 40 and at that particular age, it tends to be a little higher incidence in females. And then there is a second peak in terms of disease incidence that is after the age of 60 and that tends to be usually older males. But as I said, it can occur at almost any age. I’ve seen young kids – three and four years old and I’ve seen eight-year-old with this disease.

N: Now, I mentioned that it’s rare neuromuscular disease.

T: By definition, rare means that you have less than 300,000 people at any given time in the U.S. That’s the definition of rare diseases. Myasthenia Gravis ranges between 40,000 to 60,000 individuals at any given time in the United States. Additionally, they’re about three to four new cases per 100,000 people every year.

N: Is this something that is genetic and can it be prevented even if it is genetic?

T: This is not a genetic disease. So it’s not inherited in a typical genetic fashion. So the family members should not be concerned about inheriting this disease. However, having said that, we know that autoimmune diseases tend to keep company. Because Myasthenia Gravis is an autoimmune condition, individuals with Myasthenia Gravis may have other autoimmune conditions as well. The most common of it is autoimmune thyroid disease, something called Hashimoto’s thyroiditis or Graves disease. They can also have Vitamin B12 deficiency and a number of individuals. But Myasthenia may also develop a skin disorder called Vitiligo that results in gradual deep pigmentation of the skin. And similarly, other family members may have other forms of autoimmune diseases as well. So even though it’s not in the strict sense of the word, an inherited condition there is a susceptibility towards getting autoimmune conditions.

N: How difficult a condition is MG to diagnose properly, say in the first go-around or is it ever properly diagnosed in the first attempt?

T: So it’s very variable and part of the challenge with diagnosis, in my opinion, is the variability and presentation. So some individuals may present only with symptoms in their eyes, some individuals will present with symptoms related to their speech or this swallowing, some individuals will present with speech with a different diffused weakness in the extremities and again depending on the symptoms they have. They may present to that specific specialty. So if they have eye problems, they may go to an eye doctor. If they have ear nose and throat problems, they may go to ear nose and throat specialist. If they have generalized weakness, they may go to their primary care physician or a general neurologist. Because the disease is rare, an average community practitioner may not have seen enough of these cases to be fully proficient in terms of diagnosis or treatment. So a lot of these patients either get misdiagnosed or they are delayed …

N: Once properly diagnosed, what is the normal course of management and does that course of management vary depending on the individual patient seeing as how a young person could have it between the age of 18 and 40 and then again in 60 or above?

T: So there are minor differences in the treatment strategies. Again, we have to keep the age into consideration as well. There are different types or subtypes of Myasthenia Gravis. The treatments may differ depending on the subtypes of Myasthenia Gravis. But in general Myasthenia Gravis is a very treatable condition. This is a disease that even the sickest patients, we can look forward to stabilizing them and improving them and a number of individuals will return back to their baseline and normal self with significant improvements in quality of life. So this is one of the few neurological diseases where we can talk about almost a 100% control of this in terms about its cure because we don’t have a cure for the disease. Although, there’s a lot of work that’s happening on that we have very very good treatments for this.

N: Well, where can our listeners go and learn some more about Myasthenia Gravis and some more about you and what you do there at University of California School of Medicine?

T: So there are two Myasthenia specific resources that I would recommend is the Myasthenia Gravis Foundation of America and that’s www.mgfa.org or www.myasthenia.org and Alexion Pharmaceuticals which is helping us sponsor these awareness programs has a website which is www.talkgmg.com. And that has a lot of tips about how to deal with Myasthenia Gravis. These are the two resources that I would recommend that you can go to learn about Myasthenia Gravis. Our neurology website is neurology.uci.edu and you can get information about all our physicians including the five neuromuscular physicians who deal with Myasthenia Gravis on that website.

N: Well, particularly timely since June is, as I’ve mentioned, MG Awareness Month and I’m glad that you could come in and further educate us, Dr. Mozaffar. Thank you so much for joining us today.

T: Thank you so much.

N: I’m your host, Neal Howard here on Health Professional Radio and if you missed my conversation with Dr. Tahseen Mozaffar, you can relisten here at healthprofessionalradio.com.au. Subscribe to the podcast on iTunes, listen in and download a SoundCloud and be sure and visit our affiliates page at hpr.fm and healthprofessionalradio.com.au.

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