What is Myasthenia Gravis? You may have heard this term and thought it sounded like someone had a mouth full of marbles. Many dog owners have no idea what myasthenia gravis actually is and how it affects dogs.
What is Myasthenia Gravis?
Myasthenia Gravis is a neuromuscular disorder that can affect dogs, cats, and humans. It is caused by a deficiency of acetylcholine receptors on the surface of the muscle cells. The lack of adequate ACh-receptors causes a disruption in the signals between the nerves and muscles, leading to muscle weakness in various parts of the body.
How Dogs Get Myasthenia Gravis
Myasthenia gravis can be congenital (present at birth) or acquired. Although neither form is very common in dogs, the congenital form is rarest.
Congenital myasthenia gravis generally becomes apparent in puppies between six to eight weeks of age. These dogs were not born with an adequate amount of ACh-receptors. They typically show signs of exercise-induced weakness that can progress to paralysis and even death. Certain dog breeds are prone to myasthenia gravis, such as Springer Spaniels, Jack Russell Terriers, and Smooth Fox Terriers. Some Dachshunds are born with a form of myasthenia gravis that actually resolves on its own.
Acquired myasthenia gravis begins in adult dogs, typically around age two to four years. This is an immune-mediated form of myasthenia gravis. The dog's antibodies destroy ACh-receptors, leading to a deficiency. Acquired myasthenia gravis can affect any dog, but certain dog breeds may be predisposed.
Signs of Myasthenia Gravis in Dogs
Without the necessary amount of ACh-receptors, there cannot be effective signal transmission between muscles and nerves. The muscles become weak and cannot perform important bodily functions. Dogs with myasthenia gravis may display a number of signs.
- Exercise intolerance or weakness when exercising
- Gradually worsening weakness
- Sudden collapse or falling over
- Sleeping with eyes open
- Drooping of eyelids
- Excessive drooling
- Change to the sound of bark and/or whine
- Trouble swallowing (or excessive swallowing)
- Coughing (may indicate aspiration pneumonia)
- Difficulty breathing (may indicate aspiration pneumonia)
The muscle weakness caused by myasthenia gravis may be generalized (all over the body) or focal (only appearing in specific areas of the body). The most common focal areas affected are In either case, signs range from mild to severe.
Generalized muscle weakness due to myasthenia gravis may appear in some dogs as exercise intolerance that improves with rest. Some dogs simply have trouble walking and will tire easily. On the opposite extreme, some dogs can develop sudden paralysis due to myasthenia gravis.
Focal muscle weakness due to myasthenia gravis often affects the muscles of the esophagus, pharynx, and face. Signs can be mild to severe. Myasthenia gravis focal muscle weakness most commonly results in a condition called megaesophagus. This is perhaps the most common sign of acquired myasthenia gravis and is actually a secondary condition.
Megaesophagus is an enlargement of the esophagus (the tube that connects the throat to the stomach). The esophagus has muscles that move in a wave-like manner, sending food and liquid to the stomach. If a dog has megaesophagus, the esophagus loses muscle tone, becomes enlarged, and cannot function properly. Food and liquids may become trapped in the esophagus and/or get regurgitated (spit up) by the dog.
Megaesophagus can easily lead to aspiration pneumonia. This occurs when food or liquid is inhaled into the lungs and an infection develops. The esophagus and the trachea (windpipe) are beside one another, so food or liquid can easily get into the trachea if the muscles in that region do not properly function.
Acquired myasthenia gravis may also cause some dogs to develop a type of tumor in the chest called a thymoma.
How Vets Diagnose Myasthenia Gravis in Dogs
If you think your dog is showing signs of myasthenia gravis or any other illness, be sure to contact your veterinarian right away.
Your vet will begin by discussing your dog's history with you and then performing a thorough physical examination. Additional diagnostics, such as lab work and radiographs (x-rays) may be recommended to look for underlying issues. It is very important to rule out other diseases, disorders, or injuries before making a definitive diagnosis. Your vet may recommend you bring your dog to a veterinary specialist (usually a veterinary neurologist) to help make a definitive diagnosis.
A specific blood test (AChR antibody test) can be done to check for antibodies against acetylcholine receptors. This test can effectively diagnose most dogs with myasthenia gravis.
If your dog's symptoms are easily noticed, then a special drug may be given to check for myasthenia gravis. This is often called a Tensilon test. The dog is given an intravenous injection of an acetylcholinesterase inhibitor called edrophonium. If the dog has myasthenia gravis, then the drug will cause a significant (though temporary) improvement in the muscle weakness.
Myasthenia Gravis Treatment for Dogs
There is no cure for myasthenia gravis. Sadly, many puppies born with myasthenia gravis will not survive. However, there are treatments for acquired myasthenia gravis that can help many dogs live happy lives. In fact, some dogs even experience spontaneous remission after being diagnosed.
The key to successfully treating your dog's myasthenia gravis is to effectively communicate with your vet and stay diligent in your dog's daily care. Work closely with your vet to get your dog on the best therapeutic plan. Stick to a steady routine and report any changes in your dog's condition immediately. Medications should always be given exactly as prescribed by the veterinarian. Never make treatment adjustments without consulting your vet.
Various treatments may be used to treat dogs with myasthenia gravis.
Anticholinesterase agents (pyridostigmine or neostigmine) are prescribed to enhance neuromuscular signal transmission. These drugs can prolong the action of acetylcholine at the neuromuscular junction. Dogs with acquired myasthenia gravis usually need to remain on this type of medication for life. For many dogs, this treatment is enough to manage their symptoms.
Immunosuppressive therapy may be considered if additional treatment is needed. Because acquired myasthenia gravis is immune-mediated, immunosuppressive medications may be effective. Your vet may prescribe corticosteroids to suppress the immune system. However, immunosuppressive therapy can increase the risk of infections, especially for dogs with megaesophagus who are already prone to developing aspiration pneumonia.
Therapeutic plasma exchange is a treatment sometimes used for humans with serious cases of myasthenia gravis. This is available for dogs in some regions but it may be cost-prohibitive. TPE involves removing the "diseased" plasma and replacing it with plasma from a healthy donor. This therapy may be effective in dogs with very serious cases of myasthenia gravis.
Supportive care is a major part of treating dogs with myasthenia gravis.
- Dogs with megaesophagus should be fed large "meatballs" of food while in an upright position. This type of feeding may allow food to get into the stomach more effectively and lessen the risk of aspiration pneumonia.
- Fluid therapy may be required to avoid dehydration, particularly in dogs that regurgitate liquids.
- Medications to support the gastrointestinal system may also be helpful (metoclopramide, cisapride, cimetidine).
- Antibiotics and breathing treatments (like nebulizers) may be necessary to treat aspiration pneumonia.
- In serious cases of megaesophagus, a stomach tube may need to be surgically placed in order to deliver food directly to the stomach.
Following the diagnosis of myasthenia gravis, hospitalization may be necessary to stabilize your dog, especially if secondary issues are a concern. The hospitalization will also help your veterinarian closely monitor your dog during the medication adjustment period.
Depending on how severe your dog's disease is, daily care may be time-intensive (especially if your dog has megaesophagus). Be sure to stay organized and pay close attention to detail. However, be patient with yourself and your dog. Ask for help from friends and family members if needed. Consider joining a community of fellow myasthenia gravis dog owners or megaesophagus dog owners. Keep a log of daily medication and treatments so things are less likely to be missed.
No matter how closely you monitor your dog, it is always possible for problems to occur. Your dog may need to be hospitalized periodically to treat aspiration pneumonia or other secondary problems. This is why it's so important to communicate with your vet about any change in your dog, regardless of how small.