We have a dedicated myasthenia service at SUHT with two consultants (Dr Burke and Dr Pinto) and a specialist nurse, Lisa Joyce. We are assisted by our neurophysiology colleagues and have access to intensive care services if required. Dr Burke also has specialist expertise in childhood myasthenic disorders. Clinics are run every two weeks and there is a dedicated telephone line for enquiries.
Contact the myasthenia service
Contact specialist nurse Lisa Joyce:
Myasthenia gravis (MG) is an autoimmune disease where signalling between the nerve and muscle at the neuromuscular junction is impaired. Autoimmune diseases arise from an over-active immune response producing antibodies against normal tissues of the body. We do not know the cause of MG but some patients have an over-active thymus gland which is where antibodies are produced. Others (about 10%) have a thymoma, which is a growth in the thymus gland. In MG, the antibodies attack receptors on skeletal (voluntary) muscles that help transmit the signal from the nerve. This results in muscle weakness, and typically the weakness in MG gets worse the more the muscle is used, commonly described as 'fatigable muscle weakness'. Sometimes weakness is only noticed in the muscles that control eye and eyelid movement (ocular MG). In others, the muscle weakness is more generalised including involvement of chewing and swallowing muscles, and breathing muscles (generalised MG). The heart muscle and smooth muscle (such as the muscle lining the gut) are not affected in MG.
There are rarer myasthenic disorders affecting nerve - muscle signalling resulting in muscle weakness. These include genetic forms of myasthenia (the 'congenital myasthenic syndromes') and autoimmune Lambert-Eaton Myasthenic Syndrome (LEMS).
Myasthenic disorders are diagnosed on the basis of clinical assessment and measurement of the antibodies from a blood test. Not all patients will have antibodies and so additional tests may be done. These include electrical tests (neurophysiology), an edrophonium (or Tensilon) test and / or genetic analysis. A chest scan is often in autoimmune MG to look for thymoma a (the thymus gland is located behind the breast bone).
The autoimmune myasthenic disorders are initially treated with medications that boost the nerve - muscle signal (such as pyridostigmine). However, additional treatment with medications that suppress the immune system (such as prednisolone and other immunosuppressants) are often required. Young patients (aged less than 45 years) with detectable antibodies may be offered an operation to remove the thymus gland (called a thymectomy) as this can improve MG symptoms. Patients with a thymoma will also be offered a thymectomy; although this will not improve MG symptoms it will minimise growth of the thymoma into adjacent structures.
Further details on myasthenic disorders can be obtained from the Myasthenia Gravis Association.