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There are just around 25,000 neurologists in EU. Some regions are better covered than others: depending on the country, there are between 4 and 13 neurologists per 100,000 people.1
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Myasthenia gravis is a rare autoimmune disease that causes muscle weakness that increases with effort. This weakness gradually decreases at rest. It affects subjects of all ages, but especially young women as well as men between 50 and 60 years old.
It is due to a disruption of the immune system that produces antibodies at the neuromuscular junction, that is to say the area of contact between the nerve and the muscle. Antibodies are either directed against acetylcholine receptors that trigger muscle contraction or are directed against other components of the neuromuscular junction such as the muscle tyrosine kinase receptor or the LRP4 receptor.
Myasthenia gravis comes in different forms: ocular, bulbar and generalized.
Ocular myasthenia is localized in the muscles of the eyes. It is manifested by the fall of one or both upper eyelids, a double vision …
Myasthenia gravis affects the muscles of the throat and face. The patient has difficulty swallowing and his face is not very expressive. Example: the patient cannot smile.
Generalized myasthenia gravis affects all the muscles of the body, especially those of the shoulders, hips, jaw and neck. The patient has trouble chewing, standing, walking …
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After the observation of the various symptoms, the neurologist can confirm his diagnosis by intravenously injecting prostigmine. It is indeed myasthenia if the clinical manifestations disappear for a few hours. The test does not allow to establish a definitive diagnosis, because the result can be negative even in the case of myasthenia. The doctor will then take a blood test to detect the antibodies responsible for myasthenia gravis.
In addition, an electromyography (EMG) test can be performed for definitive proof. This consists in stimulating the nerves by electric shocks. The electromyography records the muscles to see a rapid reduction in the amplitude of the responses.
The treatment is based primarily on anticholinesterase drugs that inhibit the enzyme degrading acetylcholine. Medications can cause side effects: diarrhea, colic, loss of appetite, slow heart rate … Overdose leads to muscle cramps, hypersalivation, bronchial hypersecretion …
This drug treatment can stabilize or even eliminate manifestations. However, myasthenia gravis tends to fluctuate over time. Remissions and exacerbations of symptoms may occur; in this case corticosteroids or immunosuppressants may be used. Namely, the symptoms may worsen during the first months of pregnancy, during menstruation, during infections, after delivery or as a result of surgery requiring general anesthesia.
1736 peer-recommended neurologists have been identified by Concilio