Myasthenia gravis (MG) is a severe, potentially fatal condition of the neuromuscular system. Being autoimmune in nature, it is heavily influenced by the genetic precondition and epigenetic stresses. In this case, a woman of 41, refractory to steroidal treatment responded well to individualised classical homeopathy and has stayed symptom free for four years.
This is, as per the theory of levels of health, because of the woman being in a higher level of health. The levels of health as a clinical prognostic tool and the extent of applicability of classical homeopathy in MG need to be investigated further with larger studies.
Key words: Myasthenia gravis, individualised medicine, classical homeopathy, autoimmunity, neuromuscular, fatigue
Myasthenia Gravis (MG) is a relatively rare autoimmune disease with a prevalence of 15 – 20/100,000 population1. Being autoimmune, the autoantibodies specifically affect the neuromuscular junctions.
They symptoms are seen as easy fatigability of ocular, bulbar and skeletal muscles1. In less than a third, the autoantibodies may not be detected1. The age of onset is usually around 30 years, with a second peak at around 70 years1.
Diagnosis of MG is made by clinical/laboratory/pharmacological assessment. Clinically, it is diagnosed with the common symptomatic presentation of easy fatigability of ocular, bulbar, skeletal and respiratory muscles2.
Most commonly, the ocular muscles are involved initially and can become generalised within a few years. When the respiratory and bulbar muscles become involved, the disease is life threatening2. The clinical manifestations vary according to the autoantibodies involved, the thymic histology and age of onset.
These are acetylcholine receptor type, muscle-specific tyrosine-kinase type and low-density lipoprotein receptor-related protein 4 type. The symptomatology, treatment approach and prognosis all vary according to the clinical type.
In the laboratory, MG is diagnosed via detection of serum autoantibody and electromyography. Clinical response to cholinesterase inhibitors is also used to diagnose MG, where the patients are seronegative2.
The common mode of treatment is mostly symptomatic, with cholinesterase inhibitors and immunosuppressants. In cases where thymus is the cause, thymectomy is carried out. New approaches involve plasmapheresis, immunoglobulins and biologicals.
Immunosuppression and prednisone are still the mainstay of MG treatment with the burden of associated side effects2. Fundamentally, MG is clinically heterogenous. There is no single approach that suits all, and a personalised approach has been recommended2.
Previous reports have indicated the benefit of classical homeopathy in MG cases3. However, there have not been any large-scale studies in this direction. Here, we present a case of a clinically diagnosed MG, that benefited from individualised homeopathic therapy
41-year-old female, diagnosed with myasthenia gravis (MG) sought homeopathic treatment on 14/02/2017.
History of presenting complaints: 15 years ago, during winter, her uncle died and after this, the symptoms appeared. Droopy eyelids in both eyes (more on the right). Double vision in the evening and muscle weakness so much that she can’t carry even a handbag. She also had herniated disc, headache, forgetfulness, and sleeplessness. She used cortisone for 2 years for MG, which did not help at all.
Past medical history: All her acutes are usually accompanied by 39-40oC fever and she has acutes about twice a year. No childhood diseases or any other chronic diseases
Laboratory investigations: Her nerve muscle conduction study was normal, and she was diagnosed of Myasthenia Gravis clinically. She came to homeopathic treatment when doctors advised her to use IVIG
Family medical history Mother: diabetes and hypertension, Father: heart attack (non-fatal) and diabetes
Homeopathic case taking: The patient was discouraged because of her symptoms and was not forthcoming to questions regarding her mental/emotional state. The husband had mentioned to the homeopath that she was very jealous, but the patient refused to answer questions regarding this.
Her husband described how jealous she was with a few instances as examples. At a wedding, she was so jealous of the woman who was sitting close to her husband that she threw hazelnuts at her husband to get up from there.
Further he said that if she sees the telephone in his hand, she wants to know who he is talking with. She suspected everything about her husband’s behaviour. The husband also complained that she talked a lot, despite her sadness, especially when she was on the phone with her sisters and jumped from topic to topic.
Other symptoms: Rare haemorrhoids with pain and bleeding; Difficulty falling asleep; Slept to the left side; Desired meat (1), fish (1), sour, salt (1) and pepper (2).
Symptoms considered: Mind, love ailments from disappointed, jealousy, anger and incoherent talk with (3) mind loquacity changing quickly from one subject to another (2) discouraged (2) eye paralysis lids of upper (2) Memory weakness dates for (2) memory, weakness done for what has just (2) mind grief ailments from (2) desires fish (1) rectum haemorrhage from anus stool during (1) vision diplopia evening (2)
Fig. 1. Repertorisation of first consultation
Analysis: In this case, we see the development of the pathology after losing a dear person. Grief may trigger any remedial picture, based on the predisposition. Here, we see in her behaviour with the husband that she is a jealous person.
Such people also are usually attached greatly to their loved ones, which is probably the reason for her developing the disease. However, she seems to be of a high health level as we see that she gets high fever with the acute infections.
She probably belongs to Group A, level 2 or 3. Prof Vithoulkas teaches us that at this high health level, any pathology is potentially curable, the symptoms are very characteristic and the response quick.
Prescription on 14/02/2018: Lachesis 30C one dose.
The follow up is given in Table 1
Table. 1 Follow up of the case
|Symptoms/response to prescription
|Prescription and logic behind it
|Severe haemorrhoidal bleeding for 2 days after the remedy
|After 15 days she took remedy.She said that her symptoms were better than before. But after 1 month, the symptoms returned fully
|Lachesis 30C one dose
|Complete amelioration of symptoms. She had an aggravation of her haemorrhoids after the remedy, which had reduced later. The patient was very happy with her condition. She was more energetic, and the upper eye lids paralysis and double vision were completely better. Her husband reported that her jealousy had reduced dramatically.
|MG symptoms never recurred. The patient looked good and was happy. She loved coffee and had abstained from it for over a year. She had started coffee after one year, but the symptoms did not come back. Meanwhile, she had a severe stress from family incidents, but the symptoms still did not relapse.
However, there seems to be a milder disturbance now from the sadness and anxiety. There was some increase in the jealousy, and she had restless legs. She may require a different remedy for this state, but the MG symptoms did not return so far
A potentially life-threatening disease, MG has been demonstrated to be precipitated by intense grief4. Further, immune system changes its character and even the microbiome is shown to be different in MG patients5.
Personality types are also important to the extent that neurotic patients tend to have severe disease and more relapses6. In this case, we see a high strung, jealous person going through a phase of intense grief, triggering the disease.
However, her basic health level was high, giving a high potential for cure. The same disease in a lower health level would yield a completely different response7. Though in this case, the diagnosis was purely clinical, initial resort to steroidal treatment for over two years had not provided much relief.
With homeopathy, she became completely better with no relapses even when she underwent subsequent stress. The understanding of health levels offers a clarity like no other tool clinically. It guides analysis, prescription and follow up expectations with mathematical precision.
In this case of Myasthenia gravis, the patient was benefited with individualised classical homeopathy. This, according to the Levels of Health theory was possible because the patient was of a higher health level. Levels of health offers clarity for prescription and prognosis of a patient. We need to further explore the possibilities with classical homeopathy in Myasthenia gravis with larger studies.
- Lehnerer S, Jacobi J, Schilling R, Grittner U, Marbin D, Gerischer L, Stascheit F, Krause M, Hoffmann S, Meisel A. Burden of disease in myasthenia gravis: taking the patient’s perspective. Journal of Neurology. 2022 Jun;269(6):3050-63.
- Mantegazza R, Cavalcante P. Diagnosis and treatment of myasthenia gravis. Current opinion in rheumatology. 2019 Nov 1;31(6):623-33.
- Văcăraș V, Nistor C, Rahovan I, Văcăraş C, Vithoulkas G. Myasthenia gravis therapy with individualized homeopathy: A case report. Clinical Case Reports. 2020 Dec;8(12):2464-8.
- Bilić E, Hančević M, Sitaš B, Bilić K, Bilić H, Radić M, Delimar V, Baković M, Čikeš M, Mayer D. EMOTIONAL STRESS IN MYASTHENIA GRAVIS-THE BRIDGE BETWEEN THYMUS AND HEART. Psychiatria Danubina. 2021 May 21;33(suppl 2):184-.
- Vithoulkas G. An integrated perspective on transmutation of acute inflammation into chronic and the role of the microbiome. Journal of Medicine and Life. 2021 Nov;14(6):740.
- Bogdan A, Barnett C, Ali A, AlQwaifly M, Abraham A, Mannan S, Ng E, Bril V. Prospective study of stress, depression and personality in myasthenia gravis relapses. BMC neurology. 2020 Dec;20(1):1-6.
- Vithoulkas G. Levels of health. 3rd revised edition, ed. Alonissos, Greece: International Academy of Classical Homeopathy; 2019.