Beyond Conventional Treatments: Exploring Ayurvedic Approaches for Myasthenia Gravis

INTRODUCTION

Myasthenia gravis is a grave neuromuscular disorder, precisely a disorder of the neuromuscular junction, where the acetylcholine receptors in muscles which should receive information from acetylcholine (a neurotransmitter), are destroyed or blocked by an autoimmune reaction. Due to this block in neuromuscular transmission, the muscles do not receive information from the brain and get weakened. It is a progressive disorder which particularly affects the muscles of the eye, neck, face, mouth and throat. The condition is more prevalent in women at younger ages and in men at older ages. Management aims at strengthening the muscles, delaying the progression of the condition and improving the general state of the patient.

CAUSES

• The autoimmune reaction of the body is the main cause

• Certain drugs like ciprofloxacin may exacerbate the neuromuscular blockade

• Thymoma (a tumour of the thymus)

• Genetic defects can lead to congenital myasthenia gravis

• Emotional stress is a risk factor

SIGNS AND SYMPTOMS

• Abnormal fatigue and weakness of voluntary muscles

• Weakness of muscles worsens with continuous use and improves with rest

• Intermittent ptosis and diplopia may be the initial symptoms

• Weakness can be felt while chewing, swallowing and speaking

• Facial expression may be affected when muscles of the face are involved

• Involvement of respiratory muscles can cause respiratory failure and death

• Walking may be affected when leg muscles are involved

DIAGNOSIS

• History and examination will help to diagnose. Undue weakness which improves with rest is an indicator of the condition

• Blood tests to identify antibodies against acetylcholine receptors or other antibodies

• Electromyography (EMG)

• CT and MRI scanning to detect thymoma

• Chest X-ray for differential diagnosis

AYURVEDIC PERSPECTIVE

Myasthenia gravis is a condition resulting in weakness and reduced activity which indicates that the function of Vaata is obstructed. Thus it is an Aavaranaja Vaatha vyadhi and the aavarana is more with Kapha dosha. Therapies that can break aavarana and regulate the normal flow of Vaata must be done along with safeguarding the digestive fire and maintaining immunity.

TREATMENT PROTOCOL

Internal medications for enhancing the digestive capacity and for breaking down Aama are administered as an initial step. Further medications to regulate the immunity of the patient are also given. Along with these, suitable external therapies and any of the five cleansing therapies of Ayurveda, called as Panchakarma, are administered as per the symptoms shown by the patient. This will help to break the pathology of the condition by normalising the flow of Vaata dosha.

Following are the external therapies suiting the condition:

• Udvarthana: A procedure where the medicinal powder is rubbed all over the body in a systematic manner for a fixed duration.

• Kizhi: Application of medicine-filled poultice over the body after heating it, in a synchronised manner. This is particularly effective for nerve stimulation.

• Dhaara: Pouring of warm medicated liquid or oil all over the body in a specific pattern for a fixed duration.

• After breaking aama, Panchakarma can be done to eliminate the accumulated toxins from the body. Here, Vasthi or enema therapy is the Panchakarma of choice.

Since in most cases, eye muscles are affected, specific treatment procedures for the eyes are done here. They include:

• Sekam: Pouring of medicated liquid over closed eyes

• Ascyotana: Instilling medicated drops into open eyes

• Bidalaka: Topical application of medicated paste over eyelids

• Tarpana: Retaining medicated ghee or liquid over the eyes by making a circular boundary around the orbit using dough, for a fixed duration. This is an excellent procedure that tones the eyes.

Hospitalization and a systematic follow-up on a regular basis will be necessary for notable changes. The general condition of the patient can be definitely improved and quality of life can be increased. Along with the above therapies proper aftercare with a suitable diet and practice of yoga is required. Rasayana or rejuvenation therapy should be sought after the general course of treatment to revitalize the body tissues.