Chronic Fatigue: Should You Suspect Myasthenia Gravis?

Q: Chronic Fatigue: Should You Suspect Myasthenia Gravis?

Hello： Myasthenia gravis is considered a rare disease, with a prevalence of approximately 100-200 per million people in Taiwan, totaling around 2,000-4,000 individuals nationwide. <br>Your symptoms may need to first consider sleep issues, especially since you have metabolic syndr

If you are experiencing persistent and intermittent fatigue, should you highly suspect myasthenia gravis?

Hello, Doctor: I am a shift worker who primarily does office work.
I spend most of my day in front of a computer and do not exercise much, which has led me to develop some lifestyle-related conditions like eye fatigue and dry eye syndrome, occasional neck stiffness, hypertension, and mild hyperlipidemia, all of which I am managing with medication.
However, over the past year, I have been experiencing intermittent feelings of unexplained fatigue, even when I haven't done much.
I have undergone numerous tests at a major hospital across various specialties, but everything has come back normal, and no cause has been identified.
Recently, I came across information about myasthenia gravis online and started to feel concerned, as some of the symptoms described seem somewhat similar to what I am experiencing.
I would like to know if the incidence of myasthenia gravis is high in Taiwan.
If I have consulted multiple specialties without finding a cause for my fatigue, should I be highly suspicious that this condition could be the reason for my unexplained chronic fatigue? Thank you for your response, Doctor.

Mr. Wang, 40~49 year old female. Ask Date: 2018/07/16

Dr. Jiang Junyi reply Neurology

Hello: Myasthenia gravis is considered a rare disease, with a prevalence of approximately 100-200 per million people in Taiwan, totaling around 2,000-4,000 individuals nationwide.
Your symptoms may need to first consider sleep issues, especially since you have metabolic syndrome.
A common cause of brain hypoxia due to sleep problems is obstructive sleep apnea (OSA): if you have this condition, it can lead to daytime concentration difficulties and frequent drowsiness.

1.
Obstructive Sleep Apnea: This is the most common type, accounting for about 90% of patients.
Soft tissue near the throat obstructs the airway, causing the upper airway to become narrower, which leads to snoring and apneas.
Common triggers include anatomical abnormalities of the upper airway, excessive relaxation of the airway muscles, and obesity.
2.
Central Sleep Apnea: This occurs when the brain is unable to send signals to the muscles that control breathing due to issues such as stroke, trauma, or other problems.
Patients with this type are at increased risk for cardiovascular complications due to sleep interruptions and hypoxia, which can lead to conditions such as hypertension, arrhythmias, coronary artery disease, myocardial infarction, heart failure, and stroke.

Clinically, patients with poorly controlled diabetes and hypertension often have underlying issues with sleep apnea syndrome.
I recommend that you consult a sleep medicine specialist to discuss evaluation and treatment options.
Wishing you good health, peace, and joy.
Dr.
Jiang from the Neurology Department is concerned about you.

Reply Date: 2018/07/16

More Info

Chronic fatigue can be a perplexing symptom, especially when it seems to arise without a clear cause. In your case, given your lifestyle and existing health conditions, it’s understandable that you are concerned about the possibility of myasthenia gravis (MG). Myasthenia gravis is an autoimmune disorder characterized by weakness and rapid fatigue of the voluntary muscles. It occurs when the immune system mistakenly attacks the communication between nerves and muscles, leading to muscle weakness.

In terms of prevalence, myasthenia gravis is considered a rare condition, with an estimated incidence of about 14 to 20 cases per 100,000 people in the general population. It can affect individuals of any age, but it is more commonly diagnosed in women under 40 and men over 60. While it is not particularly common, it is important to recognize its symptoms and understand when to seek further evaluation.

The hallmark of myasthenia gravis is muscle weakness that worsens with activity and improves with rest. Commonly affected muscles include those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing. In some cases, it can also affect the muscles that control breathing. The fatigue you describe, particularly if it is accompanied by muscle weakness that fluctuates throughout the day, could potentially be indicative of MG. However, it is essential to note that chronic fatigue can stem from a multitude of other causes, including lifestyle factors, stress, sleep disturbances, and other medical conditions.

Given that you have undergone various tests and evaluations without a definitive diagnosis, it may be worthwhile to consider a few additional steps. First, you might want to consult with a neurologist who specializes in neuromuscular disorders. They can perform specific tests, such as the edrophonium test (Tensilon test) or antibody tests (anti-AChR antibodies), which can help confirm or rule out myasthenia gravis. Electromyography (EMG) can also be useful in assessing the electrical activity of your muscles and their response to stimulation.

Additionally, considering your sedentary lifestyle and the presence of other conditions like hypertension and hyperlipidemia, it may be beneficial to incorporate some physical activity into your routine. Regular exercise can improve overall energy levels and reduce feelings of fatigue. Even simple activities like walking, stretching, or yoga can be beneficial. Furthermore, managing stress through mindfulness practices or relaxation techniques can also help alleviate fatigue.

In conclusion, while myasthenia gravis is a possibility, it is essential to approach this concern with a comprehensive evaluation by a healthcare professional. Chronic fatigue can arise from various factors, and a thorough assessment will help determine the underlying cause. If you continue to experience unexplained fatigue, do not hesitate to seek further medical advice. Your health and well-being are paramount, and addressing these symptoms with a specialist can provide clarity and direction for your treatment.

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