Monica Seles Opens Up About Her Battle With Myasthenia Gravis: Here's All About This Autoimmune Disease

Tennis legend Monica Seles reveals her fight with myasthenia gravis, a rare neuromuscular autoimmune disease. Know about its symptoms, causes, and treatment options.

Tennis icon Monica Seles, a nine-time Grand Slam champion, is battling a new challenge: a neuromuscular autoimmune disease called myasthenia gravis. The 51-year-old Seles opens up about the condition she was diagnosed with three years ago. It causes muscle weakness in the arms and legs and bouts of double vision, among other symptoms. Seles was noticing odd changes around five years ago, and it eventually became apparent to her that something major was wrong.

Monica Seles's Autoimmune Disease

Monica Seles revealed, "I would be playing (tennis) with some kids or family members, and I would miss a ball. I was like, 'Yeah, I see two balls.' These are obviously symptoms that you can't ignore. And, for me, this is when this journey started. And it took me quite some time to really absorb it and speak openly about it because it's a difficult one. It affects my day-to-day life quite a lot."

What is Myasthenia Gravis?

Myasthenia gravis (MG) is the most common disorder affecting the neuromuscular junction (NMJ) of the skeletal muscles. The classic presentation is a fluctuating weakness that is more prominent in the afternoon. It usually involves muscles of the eyes, throat, and extremities. The reduced transmission of electrical impulses across the neuromuscular junction due to the formation of autoantibodies against the specific postsynaptic membrane proteins consequently causes muscle weakness. A wide variety of conditions can precipitate MG, such as infections, immunisation, surgeries, and drugs.

Causes of Myasthenia Gravis

Myasthenia gravis causes a significant number of complications. These include myasthenic crisis, an acute respiratory paralysis that requires intensive care, as well as adverse events due to long-term medication treatment like opportunistic infections and lymphoproliferative malignancies.

Symptoms of Myasthenia Gravis

The most common symptoms include the following:

• Extraocular Muscle Weakness: According to the National Library of Medicine, around 85 percent of patients reveal this during the first presentation of their cases on it (National Library of Medicine). The frequent complaints among patients are diplopia and/or ptosis. Such symptoms may advance and lead to generalised MG of bulbar, axial, and limb muscles in half of the patients within two years.
• Bulbar Muscle Weakness: It may be the first manifestation in 15% of patients and manifests itself in terms of such symptoms as difficulty in chewing and frequent choking, dysphagia, hoarseness, and a speech disorder. The participation of muscles of the face leads to a blank face, and that of the neck muscles leads to a dropped-head syndrome.
• Limb Weakness: This is observed mostly on the proximal muscles rather than on the distal muscles, and the upper limbs are affected more than the lower limbs.
• Myasthenic crisis: It is because of the intercostal muscle and diaphragm involvement, which is a medical emergency.

Diagnosis of Myasthenia Gravis

Diagnosis may involve:

• Antibody testing in blood (to acetylcholine receptor (AChR) or MuSK).
• Tests such as EMG and the edrophonium (Tensilon) challenge are neurophysiological tests.
• Visual tests such as the Simpson examination and ice packs for eyelid peculiarity.
• Imaging e.g., chest scans of thymus abnormalities

Treatment Options

While there's no cure, effective treatments exist to manage symptoms:

• Cholinesterase inhibitors: Cholinesterase inhibitors, therapeutics such as pyridostigmine, increase the strength of nerve-to-muscle transmission.
• Immunosuppressants: Prednisone, azathioprine, and the new biologics, e.g., efgartigimod and rozanolixizumab, lower damaging antibodies.
• Thymectomy: The surgical excision of the thymus gland is beneficial in most patients; approximately 60 per cent of them improve, and in some, a remission is achieved within the range of 30 per cent of the cases.
• Crisis management: IVIG or plasmapheresis during major flares; ventilatory support is needed in respiratory failure.

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