Acetylcholine: An Examination of Its Essence, Purpose, and Associations with Well-being
Myasthenia gravis is an autoimmune disorder that affects the body's neuromuscular system, causing muscle weakness. This condition, discovered by German physiologist Otto Loewi in 1914, is characterised by antibodies that interfere with the receptors for the neurotransmitter acetylcholine at the neuromuscular junction [1][5].
Key symptoms of myasthenia gravis include muscle weakness, especially in muscles that control eye and eyelid movement, facial expression, chewing, swallowing, and speaking. This weakness often worsens with activity and improves with rest. Other symptoms include ptosis (drooping eyelids), double vision (diplopia), difficulty with swallowing or chewing, slurred speech, weakness in the arms and legs, and shortness of breath in severe cases [1][5].
While there is no cure for myasthenia gravis, treatment is aimed at managing symptoms and improving muscle strength. Acetylcholinesterase inhibitors, such as pyridostigmine (Mestinon) and neostigmine, are often used for mild to moderate symptoms. These medications increase the availability of acetylcholine at the neuromuscular junction, helping to improve muscle strength [1][3][5].
For more severe symptoms, immunosuppressants like prednisone and azathioprine are used to reduce the immune system’s attack on acetylcholine receptors. Azathioprine, in particular, may provide a better treatment response in some cases, and a combination of immunosuppressants can benefit those with severe or resistant disease [2][5].
In acute or severe cases, intravenous immune globulin (IVIG) and plasma exchange (plasmapheresis) are used to temporarily counteract abnormal antibodies and rapidly remove harmful antibodies from the blood, respectively [1][3].
Surgery, such as the removal of the thymus gland (thymectomy), can reduce symptom-causing antibodies, particularly in patients with thymoma or those under 60 years old. This often results in reduced medication needs over time [1][3][5].
Balancing the levels of acetylcholine is crucial in various health conditions. For instance, experts believe that many non-motor symptoms of Parkinson's disease, such as memory problems, are related to reduced levels of acetylcholine [4]. Certain medications for Parkinson's disease help to rebalance dopamine levels, which can help relieve symptoms.
Consuming choline, a precursor to acetylcholine, might help with increasing acetylcholine levels, but there is no proven way to do so. Foods that contain choline include meat, fish, eggs, beans, and cruciferous vegetables [6]. However, high doses of choline supplements can cause side effects such as vomiting, a fishy body odour, and liver damage [2].
It's important to note that too much acetylcholine can lead to a cholinergic crisis, with symptoms including blurred vision, nausea and vomiting, diarrhea, slow heart rate, difficulty breathing, excessive sweat and saliva, more frequent and urgent urination, paralysis, etc. [3].
In summary, myasthenia gravis is a complex autoimmune disorder that affects the neuromuscular system. While there is no cure, treatments such as acetylcholinesterase inhibitors, immunosuppressants, IVIG, plasmapheresis, and surgery can help manage symptoms and improve quality of life for many patients.
References: [1] Myasthenia Gravis Foundation of America. (2021). Treatment. [online] Available at: https://www.myasthenia.org/living-with-mg/treatment
[2] Mayo Clinic. (2021). Choline. [online] Available at: https://www.mayoclinic.org/drugs-supplements-interactions/choline/oral-route/con-20022295
[3] National Institute of Neurological Disorders and Stroke. (2021). Myasthenia Gravis Fact Sheet. [online] Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Myasthenia-Gravis-Fact-Sheet
[4] Parkinson's Foundation. (2021). Non-Motor Symptoms. [online] Available at: https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Motor-Symptoms
[5] UpToDate. (2021). Myasthenia gravis: Clinical manifestations, diagnosis, and management. [online] Available at: https://www.uptodate.com/contents/myasthenia-gravis-clinical-manifestations-diagnosis-and-management
[6] National Institutes of Health. (2021). Choline. [online] Available at: https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/
- Science has made significant advancements in understanding and managing various neurological disorders, such as myasthenia gravis and Parkinson's disease, which are known to involve mental health, medical conditions like Alzheimer's disease, and health and wellness concerns related to the body's neuromuscular system.
- In addition to myasthenia gravis, researchers are exploring the role of acetylcholine imbalance in neurodegenerative conditions like Alzheimer's disease, highlighting the interconnectedness of mental health, neurological disorders, and health and wellness.
- While solutions for managing symptoms of neurological disorders, such as immunosuppressants and acetylcholinesterase inhibitors, have been developed, ongoing research is required to better understand, treat, and potentially cure conditions like Parkinson's disease and Alzheimer's disease, which are associated with cognitive decline and mental health issues.
