Diagnosis: Myasthenia Gravis

In less than three months since the initial symptoms, I’ve been diagnosed with Ocular Myasthenia Gravis (OMG) and have become overnight part of a small 'nation' of approx. 350,000 myasthenics (according to a prevalence of approx. 5 per 100,000). The diagnosis was based on a blood test called acetylcholine receptor antibody titer. Apparently 90% of the people diagnosed with MG have such antibodies detectable in their blood (while for OMG patients the percent is only 70%). This was the first and the only test performed – twice as the first time it was not performed correctly which delayed my being diagnosed with one month. However, I consider myself lucky to be diagnosed so soon as I understand that for some people it might take several years to get diagnosed and prescribed treatment. To note that my neurologist added to the diagnosis the fact that my condition was mimicking the Internuclear Ophthalmoplegia (the initial diagnosis) which might be a sign that they are still considering other causes for my double vision (although the MRI scan I had a couple of months ago eliminated the even scarier scenario of having Multiple Sclerosis).

The pathophysiology of OMG is not known to be different from the generalized MG. Basically anomalous antibodies block acetylcholine receptors with a role in activating muscles and inhibit the effect of the neurotransmitter acetylcholine at the junction between nerves and muscles. This results in muscle fatigability isolated to eyes (OMG) or affecting other groups of muscles (MG) for example muscles which control facial expressions, swallowing, chewing, breathing, limb movements – scary isn’t it?! Eye muscles seem to be susceptible to this disease. If weakness in a limb may pass unnoticed a tiny little error caused by weakness in the eye muscles would lead to the misalignment of the two eyes resulting in blurry or double vision. Different immunologic hypothesis propose that antibodies in OMG may be different than those involved in MG but further research is warranted to confirm this line of thought.

Out of the main symptoms listed for the OMG I experienced only diplopia. This initially occurred when looking down or to the side – significantly worse to the left – and after few weeks it generalized to all directions. Ptosis (drooping of one or both eyelids due to muscle weakness) is another symptom frequently reported by patients diagnosed with OMG which I have personally not experienced yet. I have to admit that at times I was under the impression that my eye lids are not symmetrical and I was terrified of the thought that my eye lid will drop soon. This may well be the result of too much reading about this condition on the Internet and expecting symptoms to exacerbate – which at this stage did not happen (Thank God!).

According to most of the web resources (more or less reliable) I’ve consulted so far 75-85% of all patients already diagnosed with MG initially complained about symptoms relating to their vision (more frequently in females). However, in OMG men seem to be more frequently affected. The average onset for MG is 33 years while for OMG is 38 years. As I was 34 years when I first developed the double vision I am closer to the onset age for generalized MG. However the fact that I am male statistically increase my chances to marry the OMG! It looks now that I am using statistics much like a drunk uses a lamppost – for support rather than illumination (as Vin Scully said) but I am definitely not losing hope that I might be among the 15-20% of the lucky patients whose MG won’t generalize to other groups of muscles. It might be a long waiting but the good news is that if I continue to have only ocular symptoms for three years, there is a good chance my symptoms will not increase!