Myasthenia Gravis: Stress, Autoimmunity & Resilience – Lessons from Monica Seles

Aug 13, 2025

Understanding Myasthenia Gravis: An Overview

Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by weakness of the skeletal muscles, which are responsible for breathing and moving parts of the body. The name 'Myasthenia Gravis,' which is Latin and Greek in origin, literally means 'grave muscle weakness.' This weakness increases during periods of activity and improves after periods of rest. While there's no cure for MG, various treatments can help manage the symptoms and improve the quality of life for those affected.

MG is relatively rare, affecting an estimated 14 to 40 people per 100,000 in the United States. It can affect people of any age, race, or gender, but it’s most common in women under 40 and men over 60. The exact cause of MG is not fully understood, but it is known to be an autoimmune disorder.

The Autoimmune Nature of Myasthenia Gravis

In MG, the body's immune system mistakenly attacks the neuromuscular junction (NMJ). The NMJ is the point where nerve cells connect with the muscles they control. Specifically, the immune system produces antibodies that block or destroy acetylcholine receptors (AChRs) at the NMJ. Acetylcholine is a neurotransmitter that is crucial for muscle contraction. When AChRs are blocked or destroyed, the muscles cannot receive signals from the nerves, leading to weakness.

In about 85% of people with generalized MG, antibodies are directed against the AChR. In the remaining cases, antibodies may target another protein at the NMJ called muscle-specific tyrosine kinase (MuSK). MuSK is essential for forming and maintaining the NMJ. Antibodies against MuSK disrupt the signaling process, leading to impaired transmission of nerve impulses to the muscles.

Common Symptoms of Myasthenia Gravis

The symptoms of MG can vary significantly from person to person and may fluctuate in severity. Some common symptoms include:

Muscle weakness: This is the hallmark symptom of MG. It typically worsens with activity and improves with rest.
Double vision (diplopia): Weakness of the muscles that control eye movement can lead to double vision.
Drooping eyelids (ptosis): Weakness of the muscles that hold up the eyelids can cause one or both eyelids to droop.
Difficulty swallowing (dysphagia): Weakness of the throat muscles can make it difficult to swallow food or liquids.
Slurred speech (dysarthria): Weakness of the muscles involved in speech can lead to slurred or nasal-sounding speech.
Weakness in the arms and legs: This can make it difficult to perform activities such as walking, climbing stairs, or lifting objects.
Fatigue: People with MG often experience excessive fatigue, even after minimal exertion.
Shortness of breath: In severe cases, weakness of the respiratory muscles can lead to difficulty breathing.

The Link Between Stress and Myasthenia Gravis

While MG is primarily an autoimmune disorder, research suggests that stress can play a significant role in exacerbating symptoms and triggering MG crises. The connection between stress and MG is complex and involves several biological mechanisms.

How Stress Affects the Immune System

Stress can have a profound impact on the immune system. When the body experiences stress, it releases hormones such as cortisol and adrenaline. These hormones can suppress the immune system, making it less effective at fighting off infections and regulating inflammation. Chronic stress can lead to dysregulation of the immune system, increasing the risk of autoimmune disorders like MG.

Studies have shown that psychological stress can alter the balance of immune cells, leading to an increase in pro-inflammatory cytokines. These cytokines can exacerbate the autoimmune response in MG, causing increased muscle weakness and fatigue. Furthermore, stress can impair the function of T regulatory cells, which are essential for suppressing autoimmune reactions.

Stress as a Trigger for MG Exacerbations

Many people with MG report that stress can trigger or worsen their symptoms. Stressful events such as work-related pressure, financial difficulties, relationship problems, or major life changes can lead to increased muscle weakness, fatigue, and other symptoms of MG. In some cases, severe stress can even trigger a myasthenic crisis, a life-threatening condition characterized by severe muscle weakness, especially in the respiratory muscles.

A study published in the journal *Neurology* found that psychological stress was significantly associated with increased disease activity in people with MG. The study showed that individuals who reported higher levels of stress were more likely to experience exacerbations of their MG symptoms.

Managing Stress to Improve MG Outcomes

Given the significant impact of stress on MG, managing stress is an essential component of MG management. Several strategies can help people with MG reduce stress and improve their overall well-being:

Mindfulness meditation: Mindfulness meditation involves focusing on the present moment and observing thoughts and feelings without judgment. Studies have shown that mindfulness meditation can reduce stress, anxiety, and depression, and improve overall quality of life.
Yoga: Yoga combines physical postures, breathing techniques, and meditation. It can help reduce stress, improve flexibility and strength, and promote relaxation.
Regular exercise: Regular physical activity can help reduce stress, improve mood, and boost energy levels. However, it's important for people with MG to choose exercises that are appropriate for their level of muscle strength and to avoid overexertion.
Adequate sleep: Getting enough sleep is essential for managing stress and supporting immune function. Aim for 7-9 hours of sleep per night.
Social support: Connecting with friends, family, or support groups can provide emotional support and reduce feelings of isolation.
Counseling or therapy: Talking to a therapist or counselor can help people with MG develop coping strategies for managing stress and dealing with the emotional challenges of living with a chronic illness.

Autoimmunity in Myasthenia Gravis: A Deeper Dive

The autoimmune nature of MG is central to understanding the disease's pathology and treatment. The immune system's misdirected attack on the neuromuscular junction (NMJ) results in the characteristic muscle weakness associated with MG. Let's delve deeper into the autoimmune mechanisms involved in MG.

The Role of Antibodies in MG

As mentioned earlier, antibodies play a crucial role in MG. In most cases, these antibodies target the acetylcholine receptors (AChRs) at the NMJ. When antibodies bind to AChRs, they can:

Block AChR binding: Antibodies can physically block acetylcholine from binding to AChRs, preventing the transmission of nerve impulses to the muscles.
Accelerate AChR degradation: Antibodies can cause AChRs to be internalized and degraded, reducing the number of available receptors.
Activate complement cascade: Antibodies can activate the complement system, a part of the immune system that promotes inflammation and further destruction of the NMJ.

In cases where antibodies are directed against muscle-specific tyrosine kinase (MuSK), the mechanism is slightly different. MuSK is essential for the formation and maintenance of the NMJ. Antibodies against MuSK disrupt the signaling process required for AChR clustering and function, leading to impaired neuromuscular transmission.

The Thymus Gland and Myasthenia Gravis

The thymus gland, located in the upper chest, plays a crucial role in the development of immune cells. In many people with MG, the thymus gland is abnormal. About 10-15% of people with MG have a thymoma, a tumor of the thymus gland. Even in the absence of a thymoma, the thymus gland may be enlarged or contain abnormal clusters of immune cells.

The thymus gland is thought to contribute to the autoimmune process in MG by producing antibodies against AChRs or MuSK. Thymectomy, the surgical removal of the thymus gland, is often recommended for people with MG, particularly those with a thymoma. Thymectomy can help improve MG symptoms and reduce the need for immunosuppressive medications.

Genetic Factors in Myasthenia Gravis

While MG is not considered a hereditary disease, genetic factors can influence the risk of developing MG. Certain genes involved in immune function, such as those in the human leukocyte antigen (HLA) region, have been associated with an increased risk of MG. These genes may influence the way the immune system responds to self-antigens and the development of autoimmunity.

However, it's important to note that having these genes does not guarantee that a person will develop MG. Environmental factors, such as infections or exposure to certain medications, are also thought to play a role in triggering the disease in genetically susceptible individuals.

Treatment Options for Myasthenia Gravis

While there is no cure for MG, various treatments can effectively manage the symptoms and improve the quality of life for those affected. The treatment approach for MG is tailored to the individual and may include:

Cholinesterase inhibitors: These medications, such as pyridostigmine (Mestinon), improve neuromuscular transmission by preventing the breakdown of acetylcholine. They can help improve muscle strength but do not address the underlying autoimmune process.
Immunosuppressive medications: These medications suppress the immune system and reduce the production of antibodies that attack the NMJ. Common immunosuppressants used to treat MG include corticosteroids (such as prednisone), azathioprine (Imuran), mycophenolate mofetil (CellCept), and cyclosporine.
Thymectomy: Surgical removal of the thymus gland can improve MG symptoms, particularly in people with a thymoma. It may also be beneficial for people without a thymoma.
Intravenous immunoglobulin (IVIG): IVIG involves infusing antibodies from healthy donors into the bloodstream. These antibodies can help modulate the immune system and reduce the autoimmune attack on the NMJ.
Plasma exchange (plasmapheresis): Plasmapheresis involves removing antibodies from the blood. This can provide temporary relief from MG symptoms, particularly during a myasthenic crisis.
Monoclonal antibodies: Rituximab and eculizumab are monoclonal antibodies that target specific immune cells or proteins. They can be effective in treating MG, especially in cases that are refractory to other treatments.

Monica Seles: A Story of Resilience

Monica Seles, a former world No. 1 tennis player, provides an inspiring example of resilience in the face of adversity. While Seles did not have Myasthenia Gravis, her experiences overcoming a traumatic event offer valuable lessons for anyone dealing with chronic illness, including those with MG. In 1993, during a quarterfinal match in Hamburg, Seles was stabbed in the back by a deranged fan of her rival, Steffi Graf. The attack not only caused physical injury but also had a profound psychological impact.

The Impact of the Attack

The stabbing incident had a devastating effect on Seles' career and personal life. She was forced to withdraw from tennis for over two years and struggled with post-traumatic stress disorder (PTSD). The attack left her feeling vulnerable, anxious, and fearful of returning to the sport she loved.

Seles' Journey to Recovery

Despite the challenges she faced, Seles showed remarkable resilience and determination. She underwent therapy to cope with her PTSD and worked tirelessly to regain her physical and mental strength. She also received tremendous support from her family, friends, and fans.

In 1995, Seles made a triumphant return to tennis, winning the Canadian Open in her first tournament back. In 1996, she won the Australian Open, proving that she could still compete at the highest level. Seles continued to play tennis professionally until 2003, achieving numerous successes and inspiring millions with her courage and perseverance.

Lessons Learned from Seles' Resilience

Monica Seles' story offers several valuable lessons for people with chronic illnesses like Myasthenia Gravis:

The importance of mental health: Seles' experience highlights the importance of addressing mental health issues, such as anxiety and depression, that can arise from living with a chronic illness. Seeking professional help, such as therapy or counseling, can be beneficial.
The power of social support: Seles received tremendous support from her family, friends, and fans, which helped her cope with the trauma and return to tennis. Building a strong support network can provide emotional support and reduce feelings of isolation.
The value of setting realistic goals: Seles set realistic goals for her recovery and gradually worked towards them. Setting achievable goals can help people with chronic illnesses maintain motivation and build confidence.
The importance of self-care: Seles prioritized self-care activities, such as getting enough sleep, eating a healthy diet, and engaging in activities she enjoyed. Self-care can help reduce stress, improve mood, and boost energy levels.
The ability to adapt and find new meaning: After retiring from professional tennis, Seles found new meaning in other areas of her life, such as writing and philanthropy. Adapting to changing circumstances and finding new sources of fulfillment can help people with chronic illnesses live meaningful lives.

Living with Myasthenia Gravis: Practical Tips and Strategies

Living with Myasthenia Gravis presents unique challenges, but with the right strategies, individuals can manage their symptoms and maintain a good quality of life. Here are some practical tips and strategies for living well with MG:

Managing Muscle Weakness and Fatigue

Plan activities carefully: Schedule activities for times when you have the most energy. Avoid overexertion and take frequent breaks.
Prioritize rest: Get adequate sleep and rest throughout the day. Avoid activities that exacerbate your symptoms.
Use assistive devices: Consider using assistive devices, such as a cane, walker, or wheelchair, to conserve energy and reduce strain on your muscles.
Modify your environment: Make modifications to your home and workplace to make tasks easier. For example, install grab bars in the bathroom, use lightweight tools, and organize your workspace efficiently.
Pace yourself: Break down tasks into smaller, more manageable steps. Avoid rushing and allow yourself plenty of time to complete activities.

Diet and Nutrition

Eat a healthy diet: Focus on consuming a balanced diet rich in fruits, vegetables, whole grains, and lean protein.
Avoid processed foods: Limit your intake of processed foods, sugary drinks, and unhealthy fats.
Stay hydrated: Drink plenty of water throughout the day to stay hydrated.
Eat smaller, more frequent meals: Eating smaller meals can help prevent fatigue and improve digestion.
Consider dietary supplements: Talk to your doctor about whether dietary supplements, such as vitamin D or omega-3 fatty acids, may be beneficial.

Medication Management

Take medications as prescribed: Follow your doctor's instructions carefully and take your medications as prescribed.
Report side effects: Report any side effects or adverse reactions to your doctor promptly.
Keep a medication log: Keep a log of your medications, dosages, and any side effects you experience.
Be aware of drug interactions: Be aware of potential drug interactions and inform your doctor and pharmacist about all the medications and supplements you are taking.

Preventing MG Crises

Avoid triggers: Identify and avoid triggers that can worsen your MG symptoms, such as stress, infections, certain medications, and extreme temperatures.
Manage infections promptly: Seek medical attention promptly if you develop an infection.
Stay up-to-date on vaccinations: Get recommended vaccinations to protect yourself from preventable infections.
Monitor your breathing: Monitor your breathing regularly and seek immediate medical attention if you experience difficulty breathing.

Building a Support Network

Connect with other people with MG: Join a support group or online forum to connect with other people with MG.
Educate your family and friends: Educate your family and friends about MG and how it affects you.
Seek emotional support: Talk to a therapist, counselor, or trusted friend or family member about your feelings and concerns.

Conclusion

Myasthenia Gravis is a complex autoimmune disorder that can significantly impact a person's life. Understanding the connection between stress, autoimmunity, and MG is crucial for effective management. Monica Seles' story of resilience provides inspiration and valuable lessons for people with MG and other chronic illnesses. By managing stress, building a strong support network, and adopting practical strategies, individuals with MG can live fulfilling and meaningful lives.

Frequently Asked Questions (FAQs) about Myasthenia Gravis

1. What are the first signs of Myasthenia Gravis?

The first signs of Myasthenia Gravis often involve muscle weakness that worsens with activity and improves with rest. Common initial symptoms include:

Drooping of one or both eyelids (ptosis)
Double vision (diplopia)
Difficulty swallowing (dysphagia)
Slurred speech (dysarthria)
Weakness in the arms or legs

2. Is Myasthenia Gravis a disability?

Yes, Myasthenia Gravis can be considered a disability, especially if the symptoms significantly impair a person's ability to perform daily activities or work. The severity of MG can vary, but many individuals with MG experience significant limitations due to muscle weakness and fatigue. They may be eligible for disability benefits and accommodations under the Americans with Disabilities Act (ADA).

3. What triggers a Myasthenia Gravis flare-up?

Several factors can trigger a Myasthenia Gravis flare-up, including:

Stress (physical or emotional)
Infections (such as colds, flu, or pneumonia)
Certain medications (including some antibiotics, beta-blockers, and muscle relaxants)
Surgery or anesthesia
Pregnancy or menstruation
Extreme temperatures (hot or cold)

4. Can Myasthenia Gravis go away on its own?

No, Myasthenia Gravis is a chronic autoimmune disorder that does not typically go away on its own. While symptoms may fluctuate and periods of remission can occur, MG usually requires ongoing treatment to manage the symptoms and prevent complications. The goal of treatment is to control the autoimmune response and improve muscle strength.

5. What is the life expectancy of someone with Myasthenia Gravis?

With proper treatment and management, the life expectancy of someone with Myasthenia Gravis is generally normal. Advances in medical care have significantly improved the prognosis for people with MG. However, severe cases of MG, particularly those involving respiratory muscle weakness leading to myasthenic crisis, can be life-threatening if not treated promptly.

6. What kind of doctor treats Myasthenia Gravis?

Myasthenia Gravis is typically treated by a neurologist, a medical doctor who specializes in disorders of the nervous system. A neurologist with expertise in neuromuscular disorders is best equipped to diagnose and manage MG. Other healthcare professionals who may be involved in the care of people with MG include:

Primary care physician
Endocrinologist (if there are associated thyroid issues)
Pulmonologist (if there are respiratory complications)
Physical therapist
Occupational therapist
Speech therapist