Can You Have Myasthenia Gravis Without Obvious Symptoms? - Neurology

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Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder characterized by varying degrees of weakness of the skeletal muscles, which are responsible for breathing and moving parts of the body. The hallmark of MG is muscle weakness that worsens after periods of activity and improves after periods of rest. While the classic symptoms of MG include ptosis (drooping eyelids), diplopia (double vision), dysphagia (difficulty swallowing), and generalized muscle weakness, it is indeed possible for individuals to have Myasthenia Gravis without exhibiting obvious or classic symptoms.

In your case, the symptoms you describe, such as muscle tightness around the eyes and dry eyes, could potentially be related to MG, but they are not definitive indicators. The fact that you experienced pupil constriction after using neostigmine eye drops is interesting, as neostigmine is a cholinesterase inhibitor commonly used to treat MG. Pupil constriction (miosis) is not a common side effect of neostigmine in the general population, but it can occur in individuals with MG due to the drug's action on the neuromuscular junction.
Regarding the symptoms of night sweats and palpitations, these are not typically associated with MG itself. However, they could be related to other underlying conditions or stressors, including anxiety or autonomic dysregulation, which you mentioned experiencing. It is important to note that while MG primarily affects voluntary muscles, it can have systemic effects, particularly if it leads to respiratory muscle weakness or if there are associated conditions.

Your concerns about the variability of your eyelid heaviness and the relief you feel from heat application suggest that your symptoms may not be solely due to MG. The fluctuation in symptoms can also be indicative of other conditions, such as chronic fatigue syndrome or even anxiety-related muscle tension.
It is also worth mentioning that stress and lack of sleep can exacerbate symptoms of many conditions, including MG. The autonomic nervous system, which regulates involuntary bodily functions, can be influenced by stress, leading to symptoms such as palpitations and night sweats.
As for the ongoing tests and evaluations by your neurologist, they are crucial for determining the presence of MG or any other neuromuscular disorder. Diagnostic tests for MG may include blood tests for antibodies, electrodiagnostic studies, and possibly a CT scan to check for thymoma, which is associated with MG.

In summary, while it is possible to have Myasthenia Gravis without obvious symptoms, the presence of your current symptoms does not definitively indicate MG. The side effects you experienced from neostigmine, along with the symptoms of night sweats and palpitations, warrant further investigation by your healthcare provider. It is essential to maintain open communication with your neurologist and discuss all your symptoms and concerns to arrive at an accurate diagnosis and appropriate treatment plan.