multiple images of the same woman in a winter coat and gloves, struggling with her MG symptoms in the cold

Managing Myasthenia Gravis Flares

Myasthenia gravis (MG) is a chronic (long-term) autoimmune disorder. MG is caused by antibodies attacking receptors in muscles. This destroys how nerves and muscles communicate, which results in muscle weakness. It mostly affects muscles in the eyes, mouth, limbs, and throat.1,2

People with MG have treatment options to help control muscle weakness and calm the immune system. Treatments include medicines, surgery, and lifestyle and alternative treatments. However, even with treatment, MG flares can still happen.3

What are flares?

A flare is when the symptoms of MG become more frequent or more severe. This is the opposite of a remission, which is a decrease in symptoms. The symptoms of an MG flare are the same symptoms as MG. These include:1,2

  • Weakness of eye muscles that causes blurred or double vision
  • Drooping of 1 or both eyelids
  • Trouble swallowing or chewing
  • Trouble speaking
  • Muscle weakness and fatigue
  • Neck or limb weakness
  • Shortness of breath

MG flares can come from specific events called triggers. These can come from a variety of places. They can be emotional, environmental, or due to other changes.4

Some triggers are common to many people with MG, while some are unique. Triggers for MG flares can include:4

  • Stress or anxiety
  • Not getting enough sleep
  • Humidity
  • Extreme temperatures (hot or cold)
  • Some medicines, such as beta blockers, antibiotics, and calcium channel blockers
  • Some chemicals, including those in household products
  • Illness

How are they different from a crisis?

While myasthenic crises are rare, an MG flare can develop into an myasthenic crisis if not treated. A crisis occurs when a person with MG has extreme muscle weakness and issues breathing. This is mainly due to muscle weakness of the diaphragm and chest muscles.1,2

In a crisis, breathing may become shallow or ineffective. Crises can be caused by a lack of medicine or other factors similar to an MG flare. Flares are more common and milder than crises.1-3

It is important to watch for any symptoms of an MG flare. If you have any symptoms, contact your doctor as soon as possible. This can help you and your doctor take steps to prevent an MG flare from developing into a myasthenic crisis.

How to manage

In most cases, the first step in managing MG flares is to address any external causes. For example, this could mean treating an illness or stopping medicine that causes a flare.3,4

Lifestyle and alternative treatments may also help manage some MG symptoms. Steps you can take to prevent or ease a flare may include:2

  • Using vocal strengthening exercises
  • Trying different ways to communicate, like gesturing, writing, being asked yes/no questions
  • Eating smaller, more frequent meals
  • Eating softer foods
  • Having meals about 1 hour after taking your MG medicine
  • Resting before meals
  • Avoiding talking when possible

Some of these steps will work for some people and not others.

There are other ways to lessen a flare, as well. Increasing the dosage of your MG medicine is 1 example. In some cases, it may be best to monitor the course of the flare and only treat external factors, like infection.3

Treatments can work differently for each person. If you have an MG flare, talk to your doctor to figure out which path of treatment is right for you.

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