When discussing muscle weakness, most people would assume it is a condition directly related to the muscles. However, muscle weakness can actually be caused by either Myasthenia Gravis or Amyotrophic Lateral Sclerosis (ALS). Although both conditions are referred to as "muscle weakness" in Thai, their causes and symptoms are different, and the chances of them occurring together are very low. In this discussion, we will explore the similarities and differences between these two diseases.
Getting to know muscle weakness:
Myasthenia Gravis, or MG, is a chronic type of body allergy. It occurs due to a malfunction of the body's immune system, leading to a loss of contact between nerves and muscles. As a result, patients feel weak, and their muscles are unable to work at full efficiency. This weakness can affect muscles throughout the body.
On the other hand, Amyotrophic Lateral Sclerosis, or ALS, is caused by a malfunction of the command neurons, which results in muscle weakness due to a lack of nerve cells to control commands. Over time, the cells in the brain and spinal cord responsible for this control deteriorate and eventually die.
Currently, there is no clear evidence regarding the causes of these two types of muscle weakness. However, there is an assumption that they may originate from the Thymus Gland in the chest area. This gland might be associated with the production of antibody proteins that interfere with the function of Acetylcholine, responsible for sending signals from nerves to muscles.
While these diseases can be transmitted from mother to child during pregnancy, the chances of transmission are very small.
Warning signs of muscle weakness:
If you or someone close to you starts experiencing the following symptoms, it may indicate muscle weakness, and it is important to see a doctor for diagnosis as soon as possible.
• Weakness in the muscles of the limbs, such as an inability to raise the arm above the head or to clench the fist.
• Drooping wrists or ankles.
• Frequent stumbling, falling, or difficulty climbing stairs.
• Trouble squatting or getting up.
• Difficulty swallowing or changes in voice.
• Muscle atrophy or muscle spasms.
• Symptoms that start gradually and progressively worsen.
Symptoms of muscle weakness:
Although both MG and ALS are called "muscle weakness" in Thai, they present distinct symptoms. The details of the symptoms are classified according to the respective diseases as follows.
Symptoms of MG: The muscles of various organs become so weak or exhausted that they cannot perform normal activities. This includes eye muscles, facial muscles, neck muscles, and limb muscles. Additionally, patients may experience the following symptoms:
• Droopy eyelids in one or both eyes, which is often the first noticeable symptom.
• Double vision, blurry vision, etc., with symptoms improving when one eye is closed.
• Nasal speech or softer sound.
• Difficulty swallowing and a tendency to choke on food.
• Fatigue in the mouth muscles after chewing, as the muscles around the mouth, soft palate, or tongue weaken.
• Changes in facial expression, such as reduced smiling or a smile that appears forced due to the inability to control facial muscles.
• Weakness in the neck, difficulty maintaining an upright head position.
• Weak legs, making it difficult to walk or resulting in a waddling gait.
• Difficulty breathing and respiratory failure, as the muscles used in breathing are weak, especially when lying down or after exercise.
Symptoms of ALS begin with weakness in the hands, feet, arms, or legs on one side before progressing to other areas of the body. The symptoms include:
• Difficulty walking or performing daily activities.
• Frequent stumbling or falling.
• Weakness in the hands, making it difficult to hold objects.
• Slurred speech and a stiff tongue.
• Spasms or cramps in the arms, shoulders, and tongue.
• Difficulty swallowing.
• Uncontrollable crying, laughing, or yawning at inappropriate times.
Is muscle weakness curable?
Neither type of muscle weakness has a cure. However, there are ways to treat the symptoms. Doctors may employ the following methods to control or alleviate the severity of symptoms:
· MG:
o Administration of medication: such as Pyridostigmine, which stimulates the connection between nerves and muscles, making the muscles stronger.
o Thymus surgery: while the link between the disease and the thymus gland is not clear, removing the thymus gland can alleviate muscle weakness.
o Plasmapheresis: This involves filtering the liquid part of the blood to remove antibodies that disrupt nerve-muscle interactions.
o Intravenous immunoglobulin: This treatment uses antibodies to regulate the immune system. Its effects typically last for 3-6 weeks.
· ALS:
o Administration of medication, such as oral or parenteral Edaravone, to slow down the progression of the disease. However, this medication does not cure ALS.
o Physical therapy: This includes using assistive devices to help with daily activities and maintaining muscle strength and efficiency.
o Meal planning: To address and cope with swallowing difficulties. In some cases, a gastrointestinal tube may be inserted.
o Speech therapy: To aid in communication, even when the muscles involved in speaking are weakened.
Diagnosis and treatment of muscle weakness:
• Neurological examination, including tests for response, muscle strength, sense of touch, balance, and vision.
• Blood test: Counting the number of antibodies. Those at risk for muscle weakness may have an abnormally high number of antibodies that inhibit muscle function. The presence of the anti-MuSK antibody is commonly detected.
• Nerve Conduction Test: This can be done in two ways. The Repetitive Nerve Stimulation Test stimulates the nerve repeatedly to assess the muscle bundle's function. Electromyography measures the electrical current from the brain to the muscles to evaluate single-fiber electromyography (EMG).
• Edrophonium Test or Tensilon Test: This test involves injecting Edrophonium Chloride to activate muscle contractions. It helps diagnose muscle weakness when abnormalities are found in blood tests and electrical tests. However, this method may cause side effects such as heart and breathing problems, and it is usually performed by a skilled neurologist. It is not a preferred diagnostic method.
• Computerized Tomography or Magnetic Resonance Imaging: These imaging techniques are used to identify tumors or abnormalities in the thymus gland.
• Pulmonary Function Tests: These tests assess lung function and breathing capacity.
• Ice Pack Test: As an additional test, an ice pack is placed on the affected area for 2 minutes to analyze the recovery from ptosis for further diagnosis.
Complications:
Both types of muscle weakness can be treated to improve symptoms. However, if left untreated, there is a risk of complications, such as:
• Myasthenic Crisis: When the muscles responsible for breathing weaken, the patient becomes unable to breathe independently.
• Thymus gland tumor: There is approximately a 15% chance of a thymus gland tumor occurring in patients with muscle weakness.
• Hypothyroidism: The thyroid gland, located in the front of the neck, regulates metabolism through hormone secretion. Complications of hypothyroidism can manifest as chills and weight gain. On the other hand, complications of hyperthyroidism may lead to fever and weight loss.
• There is also a risk of other autoimmune diseases such as Systemic Lupus Erythematosus.
Prevention of Muscle Weakness:
Muscle weakness can be prevented by implementing certain lifestyle changes and making mindful food choices. Here are some preventive measures:
• Engage in daily exercise to prevent muscle weakness and promote muscle strength and restoration.
• Ensure you get sufficient rest and prioritize quality sleep, as it plays a crucial role in muscle recovery and overall health.
• Opt for a diet that includes foods rich in antioxidants and carotenoids. These can be found in yellow, orange, and red vegetables and fruits such as broccoli, carrots, bell peppers, and more.
Remember, healthy food is considered the best medicine in preventing muscle weakness. For more information on KTAXA Health, Krungthai-AXA Life Insurance customers can visit https://www.krungthai-axa.co.th/th/HealthServices .
References
· The Asian parent website
· Pobpad website
· Sikarin Hospital
· MedPark Hospital
· Vibhavadi Hospital
· Phyathai Hospital
· Rajavithi Hospital
· Hellokhunmor website
