Brighton, MA - St. Elizabeth’s Medical Center Neurologist Dr. Michael Slama was recently highlighted by the Myasthenia Gravis Foundation of America (MGFA) for his work around myasthenia gravis (MG), an autoimmune neuromuscular condition. Dr. Slama is chief of the neuromuscular medicine service and director of the EMG laboratory at St. Elizabeth’s Medical Center.

What is myasthenia gravis (MG)?
Myasthenia gravis (MG) is an autoimmune neuromuscular condition that causes muscle weakness. In MG, antibodies interfere with the normal communication between nerves and muscles, leading to fluctuating and sometimes unpredictable symptoms that can include double vision, droopy eyelids, slurred speech, difficulty chewing, difficulty swallowing, difficulty breathing, and weakness of the arms, legs or neck. MG symptoms typically worsen with increased activity of the affected muscle and improve with rest. In 10 to 15% of cases, the condition is associated with an underlying tumor of the thymus gland (called a thymoma).

Who is at risk for developing MG and who does it affect most? Does heredity play a role?
MG is rare and is estimated to affect between 7 and 37 individuals per 100,000. MG can occur at any age, though younger women (< 40) and older men (> 60) are more commonly affected. There are no definite factors clearly shown to increase the risk for developing MG, though having other autoimmune conditions likely increases the risk. Autoimmune MG is not a hereditary condition.

How is the condition diagnosed?
Myasthenia gravis is diagnosed based on presentation of symptoms and a detailed neurological examination, supported by diagnostic tests. The most common tests used to make the diagnosis are laboratory tests that check for antibodies causing this condition. In some cases, electrodiagnostic testing (nerve conduction studies and electromyography) are necessary to reach a diagnosis. The most sensitive test for the diagnosis of MG is single fiber electromyography (SFEMG). SFEMG is a complex technique performed by specially trained neuromuscular neurologists. St. Elizabeth’s is one of a handful of centers in Massachusetts to offer this procedure.

How is MG treated? 
There are numerous options to treat MG and every case is treated differently. Mild cases can be treated with medications that improve neurotransmission at the junction between nerves and muscles. However, most cases require suppressing the immune system via oral, subcutaneous, or intravenous medications, sometimes in combination. A surgical procedure to remove the thymus gland can be helpful in some cases. There has been a rapid expansion of FDA approved treatment options for MG in the past few years and even more therapies will likely become available in the coming years.  

Please discuss the care you provide for patients who have MG. 
At St. Elizabeth’s, we provide expert MG care tailored to the individual needs of several hundred patients with MG. We also provide second opinions or expert consultations to support patients primarily treated by local neurologists less familiar with the condition. We support a large network of physicians (primarily neurologists and ophthalmologists) throughout Massachusetts and neighboring states to assist in timely diagnosis and treatment. We coordinate specialized therapies with home infusion companies and ambulatory infusion centers. There are also support groups available: https://myasthenia.org/MG-Community/Find-MG-Support-Groups

You were featured recently by the Myasthenia Gravis Foundation of America (MGFA) 
The MGFA has been instrumental in raising awareness around MG. The MGFA maintains a network of MG experts nationwide so patients can more easily find an MG neurologist in their area. St. Elizabeth’s has a long history of being a center of excellence for MG diagnosis and treatment, thanks to the efforts of Dr. David Weinberg who has been a leader in the field for the past several decades. Dr. Weinberg and I have been privileged to be recognized as “Partners in MG care” by the MGFA. Working with the MGFA helps raise awareness for this rare disease with the hope of shortening time to diagnosis and ensuring more patients get on the right treatment for the condition.  We are also a site for two phase 3 clinical trials for potential novel therapies in MG.

Anything else you would like to add?
High quality MG care at St. Elizabeth’s would not be possible without our dedicated team of health care providers, EMG technicians and administrative assistants. Dr. David Weinberg has played a crucial role in building our renowned MG program and continues in an advisory role and conducting studies in the EMG lab. Olivia Johnson, PA-C joined the program last year and is instrumental in ensuring that complex treatment plans for our MG patients are implemented. Our administrative team and in particular Nia Nirola play a lead role in triaging referrals, which has accelerated the time to diagnosis and treatment from months to weeks. Our EMG technicians under the leadership of Maureen Walsh help diagnose MG with high quality nerve conduction studies. 

Physicians and physician extenders in our network should know that we are here as a resource. We can facilitate expedited neuromuscular consultations and/or electrodiagnostic testing for patients who they think may have MG.

Dr. Slama’s practice is located at St. Elizabeth’s Medical Center, 736 Cambridge St., Brighton, MA. The office may be reached at: 617-789-2375.

About St. Elizabeth's Medical Center
St. Elizabeth's Medical Center, a Boston University Teaching Hospital, offers patients access to some of Boston's most respected physicians and advanced treatments for a full range of medical specialties, including family medicine, cardiovascular care, women and infants' health, cancer care, neurology care, and orthopedics. The 306-bed tertiary care facility is part of Steward Health Care. For more information, visit www.semc.org.

About Steward Health Care 
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability. 

As the country’s largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world. 

Based in Dallas, Steward currently operates more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas. For more information, visit steward.org.