The name myasthenia gravis is derived from Latin and Greek and means "grave muscle weakness." The hallmark of myasthenia gravis is chronic muscle weakness that increases during periods of activity and improves after periods of rest. Torage Shivapour, MD, director of clinical services in the Department of Neurology at University of Iowa Hospitals and Clinics, talks about myasthenia gravis:

What causes myasthenia gravis?

The cause of myasthenia gravis is a breakdown in the normal communication between nerve and muscle. To give an example or to simplify this matter, if I ask you to make a fist with your right hand, your brain will receive the information, process that, and make it happen by sending a signal via nerve to your right hand muscle. However, there is no direct contact between the nerve and muscle. The nerve endings come very close to the surface of the muscle and they release protein referred to a neuro transmitters Acetylcholine which convey this message by bonding to the receptors on the surface of the cell, and make it contract

What are the symptoms of myasthenia gravis?

Because myasthenia gravis affects the voluntary muscle, it can simply involves the facial. It can cause facial muscle weakness; it can cause droopy eyelids, double vision, distorted vision, difficulties with chewing or swallowing, trouble with talking at times, trouble with weakness involving upper or lower extremities, and shortness of breath--difficulties breathing.

Who is most likely to develop myasthenia gravis?

Myasthenia gravis is an autoimmune disease. We all have an autoimmune system to protect us from foreign bodies. In patients who have autoimmune disorders, their immune system turns against itself and begins to cause problems by making antibodies to bind, destroy, or reduce the number of the positive proteins or Acetylcholine. For example, diabetes is an autoimmune disease as are thyroid disease, myasthenia gravis, multiple sclerosis, lupus, rheumatoid arthritis. There is a host of autoimmune diseases which is in part genetic and the other part that's what happens.

How is myasthenia gravis diagnosed?

Like any neurological disease, the diagnosis of myasthenia gravis goes back to the basic principle--a good medical history. I was taught 35 years ago that if you listen to your patients, 50 percent of the time they direct you toward the diagnosis. So if I listen to my patients and get a good history, they tell me I wake up in the morning and I feel fine. But as the day goes on, if I work at the computer, I see double. If I'm going upstairs/downstairs, I become short of breath. If I am talking too much, I have trouble swallowing. It makes me think about myasthenia gravis, then a good physical and neurological examination, and then laboratory studies. We can do blood tests to identify myasthenia gravis. We can do a pulmonary function or breathing test, we get a CT scan of the chest to rule out tumor of the thymus gland, we do electrophysiological testing, combining all together, we can come to the accurate diagnosis almost all of the time.

How is it treated?

The treatment of myasthenia gravis is common sense. The body does not provide enough material, enough protein for the patient with myasthenia gravis to go. So we tell them: do not abuse your body, do not over do it, and conserve energy. If the person with myasthenia gravis decides to do landscaping from 8 a.m. to 6 p.m., no matter how much medicine you give them, they're going to get sick.

For someone with myasthenia gravis, what is the prognosis?

Before I go to prognosis, we have good medications for treatment of myasthenia gravis. We can give them medications to improve their symptoms, we can give them medications to suppress their immune system, however, most medications have side effects. On the other hand, if you have no choice, you just go ahead and treat anyway. The prognosis of myasthenia gravis in this day and age is very good. As you refer to the name--myasthenia gravis--grave muscle weakness, in this day and age we don't have it like that any more. We can treat most of our patients, and the prognosis is relatively good if they cooperate and do their parts, they can have a normal life expectancy.

Is UI Hospitals and Clinics involved in any research with regard to myasthenia gravis?

We do not have, at this time, ongoing clinical research for myasthenia gravis, but at basic science and molecular levels, there are ongoing studies in regard to why does the immune system malfunction. That will be the principle and hopefully that will help to come with better treatment and maybe, who knows, and sometimes a cure.

If somebody is listening to this and thinks it sounds like symptoms they may be suffering from, how do they get in touch with you or someone else at the UI Hospitals and Clinics?

In this day and age, the internet age, I have a sign in my exam room. It says: "I already have diagnosed myself. I'm here only for a second opinion." That's a fact. Unfortunately, people that self diagnosis, they read the lines. As professionals, we read between the lines. I have patients who come with self diagnosed multiple illness. There are many times that is not the case.

If they think they have myasthenia gravis, they can talk to their primary care physician, get a second opinion with a specialist, which could be a neurologist; and we do the proper laboratory studies. We can come very close to 95 or more percent accurate diagnosis.

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Torage Shivapour, MD