Myasthenia gravis - causes, symptoms and treatment with homeopathy

Myasthenia gravis – causes, symptoms and treatment with homeopathy



Hereby, we present a case of a 64 years Male diagnosed with Myasthenia, a known case of  Diabetes Mellitus treated with Homoeopathy in its acute state showing recovery without  conventional mode of treatment.  

Myasthenia cases require immediate action from the beginning to avoid bad prognosis &  homeopathy has a good impact on neuromuscular disorders with good outcome in long-term  treatment. However, it is equally important to bring back the deteriorated state of health with  Rapid recovery. This case was chosen for the purpose of study as well as to demonstrate the  efficacy of individualized Homeopathic treatment in case of Myasthenia Gravis. 

Key words: Homoeopathy, Myasthenia Gravis, Curare, Causticum, Diabetes 


Myasthenia gravis is the most common cause of acutely evolving, fatigable weakness and  preferentially affects ocular, facial and bulbar muscles.[1]  

It is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle  weakness. It can result in double vision, drooping eyelids, trouble talking and  walking. The onset can be sudden. [2] 

This condition is characterized by progressive fatigable weakness, particularly of the ocular,  neck, facial and bulbar muscles.[5] 


Caused by autoantibodies to acetylcholine receptors in the  post-junctional membrane of the neuromuscular junction, Myasthenia is characterized by the blockage of  neuromuscular transmission by these antibodies which initiate a complement-mediated inflammatory response. This reduces the number of acetylcholine receptors and damages the end plate.  

A minority of patients have other autoantibodies to epitopes on the post-junctional  membrane, in particular autoantibodies to a muscle-specific kinase (MuSK), an agrin receptor which is involved in the regulation and maintenance of the acetylcholine receptors.  

About 15% of patients (mainly those with late onset) present with a thymoma, and a huge chunk of the remainder show thymic follicular hyperplasia. An increase in the incidence of other  autoimmune diseases is seen, and the disease is linked with certain HLA haplotypes. Factors which trigger the disease itself are still unknown to us, but penicillamine can cause an antibody mediated myasthenic syndrome which may persist even after drug withdrawal. Some drugs,  especially aminoglycosides and ciprofloxacin, often exacerbate the neuromuscular blockade  and should be avoided in patients with myasthenia[5] 


The disease is most commonly seen between the ages of 15 and 50 years, with the sex ratio showing women affected more  often than men in the younger age groups and the reverse at older ages. A  relapsing and remitting course is seen especially during the early years.[5]

The cardinal symptom is abnormal fatigable weakness of the muscles (which is different  from a sensation of muscle fatigue); the muscle movement is strong initially but rapidly declines.  Worsening of symptoms is typically seen towards the end of the day or following exercise.  There are no sensory signs or signs of involvement of the central nervous system, although  weakness of the oculomotor muscles may mimic a central eye movement disorder.[5] The initial symptoms are usually intermittent ptosis or diplopia, but gradual development of weakness of chewing,  swallowing, speaking or limb movement occurs. Any limb muscle may be affected, most  commonly those of the shoulder girdle; the patient is unable to undertake tasks above  shoulder level, such as combing the hair, without frequent rests. In some cases respiratory muscles may be  involved, and in these cases respiratory failure becomes a common cause of death. Aspiration may also occur if  the cough is ineffectual. Sudden weakness from a cholinergic or myasthenic crisis may require ventilatory support.[5] 


A 64 Years old, male Diabetic patient presented with Ptosis & difficulty in swallowing of  food. His chronology of symptoms- drooping of lids, difficulty in chewing food, difficulty in  swallowing solids and lastly difficulty in speaking too. 

Chief Complaint: 

C/o – Drooping of eyelids involuntarily, (right >left) started almost one month ago (better at rest and morning & worsen as the day passes).   – Difficulty in swallowing solid foods since last one day. 

 Difficulty in chewing since 15 days (“I thought it is because of his denture”)  – It was difficult for him to Speak due to weakness also 

 Occipital headache since a very long period, > spontaneously. 

Generals: Appetite- Good but unable to eat as chewing and swallowing are difficult. He complained- “I  have to hold my Lower Jaw while eating.” 

 Thirst + 

 Desire- Sweets++ 

 Aversion- Hard food 

 Habit- Tobacco chewing 

 Stool – Constipation chronic >after passing stool 

 Urine- Normal, sometimes offensive. 

 Perspiration- Not much 

 Thermal- Chilly 

 Sleep- Normal- sound. Position-lateral

 Dreams- Not at such  

Mental generals: 

Retired Electrical Engineer. Now has a sedentary lifestyle. Anxious if cannot get ready in time. Angry easily. “I will shout and express anger”. Can’t tolerate injustice or false  statements. Sensitive to emotional impressions like weeps while seeing emotional scenes on TV or after hearing bad news. Grief about his mother’s death recently.  


ICD-10 code G70. 00 for Myasthenia gravis without (acute) exacerbation is a medical  classification as listed by WHO under the range – Diseases of the nervous system. 

History – Diploma, ptosis, dysarthria, dysphagia, dyspnea, weakness in proximal limbs, neck  extensor, generalized 

Fatigue, worse with repeated activity. 

Physical examination – 

Ptosis, diplopia 

Motor power survey: quantitative testing of muscle strength 

Forward arm abduction time (5min) 

Vital capacity measurement 

Absence of other neurologic signs 


Patient was referred to visit Neurophysician. 



 ACH-R -POSITIVE (10.26) 

 RBS- 176 

 HbA1C- 9.56 




Prognosis- was found to be poor as patient had bulbar weakness

Case Analysis – 

Analysis of the symptoms 

Ptosis – Physical – particular- common symptom 

Difficulty in chewing & swallowing solids – physical – Particular – Common symptom 

Difficulty in speaking – Physical – particular- common symptom 

Occipital headache- Physical – particular- common symptom 

Diabetes mellitus – Physical – General- common symptom 

Totality of symptoms: 

• Drooping of upper eyelids 

• Speech slurred 

• Diabetes mellitus 

• General paralysis 

• Neurological complaint 

Repertory chart

The remedy- Curare 

Final Selection of remedy – 

Curare: Muscular Paralysis without impairing sensation and consciousness. Reflex action  diminished. Debility of the aged. [2] 

This remedy is one of the top remedies in clinical practice for Myasthenia Gravis, especially when the patient presents with the suppressed grief of Ignatia. There is muscular  paralysis with impairing sensation and consciousness, along with paralysis of respiratory  muscles. The reflex action is diminished. Curare decreases the output of adrenaline. [3] 

Paralysis of extensor muscles, often with rapid progression.  

ALS. Guillain-Barre. Myasthenia.  

Sensory: Relatively spared, nearly normal.  

Motor: Paralysis of extensor muscles, especially forearm, deltoids and shoulder. The lower  limbs may also be affected.  

Weakness or drooping of lids.  

Swallowing difficult; must drink to force food down.  

Paralysis of respiration in advanced neurological degeneration.  

Signs: Decreased or absent tendon reflexes. Loss of gag reflex.  

Mental: Deeply negative; abusive of self or others.[4] 

Noteworthy Symptoms 

Ptosis of right side 

Facial and buccal paralysis 


Neurological disorders 

Aversion to company, shut herself up, avoids the signs of the people. 

Debility of the aged. [3] 


04/12/20- Owing to the severity of the case and low susceptibility of the patient, CURARE  30 QDS was given for 3 days.  

Follow ups & Prescription 

6/12/20:No ptosis  Speech improving now can speak in starting then bubbled again  Chewing and difficulty in swallowing not improved. Weakness reduced Ix – FBS – 150mg/dl, PP2BS – 167mg/dl Rx- Continued Curare 30 QDS 
7/12/20Feels better  Ptosis much better – now can open and closed eyes voluntarily  Can chew food well but takes time so avoids eating.  Speaks few sentences but still babbled sometimes after continuous talking.  : Rx- Curare 200 single dose OD * 2 days(dissolve in one cup water and take 2tsf only)
9/12/20No Ptosis now  Speech much better   Swallow’s food now. Jaw holding+ while chewing. Ix – FBS – 161mg/dl Rx- Curare 1M Single dose diluted with one cup water and take 2tsf only. 
10/12/20much better  Speech – normal but still babbled sometimes  Feels sensation of food swallowing through throat Ix – FBS – 141mg/dl Rx- Continued the same as on 9/12/20 
13/12/20Chewing good  Speech – babbled sometimes Ix – FBS – 261mg/dl Rx- Given Curare 1M similarly Sac Lac 4BD for 07 days Advice- Follow up after 1 week 
09/03/21Again started having mild ptosis.  Chewing difficulty+Rx Curare 1M single dose was given Saclac 30 4 pills twice a day for 7 days 
16/03/21Not much improved. Ptosis right eye+  Chewing difficulty stil+  RBS-189 Rx Causticum 1M was given single dose Saclac 30 4 BD for 7 days 
23/03/21Much better nowRx Saclac 30 4 BD for 15 days


It was one of the most difficult cases and needed urgent relief as the symptoms were  aggressive. The accuracy was very mandatory. In such types of cases, it was extremely  important to monitor closely and also was necessary to receive inputs from specialists and  follow necessary advice. A team work or group discussion helps in doubt and found  Respected Sarkar’s literature much beneficial in acute crisis. 

He was strictly advised to abstain from Tobacco and follow strict dietary advice including Vegan  diet, as well as physiotherapy for strengthening muscles which he followed perfectly and all this was much beneficial in bringing appropriate recovery along with Homoeopathic Medicines. His  HbA1C improved and was 6.6 on 31/03/2021. His Ach R- 0.11 Negative (not  mandatory but was rechecked). 

Patient improved gradually. Later Causticum 1M single dose was given when again the  symptoms relapsed and repeated as and when required. Patient is hemodynamically stable till  date. 

[NOTE: – Causticum 1M was given on the basis of his physical and mental symptoms 

Right sided paralysis of face. Intensely sympathetic. A/F- Long lasting grief, sudden  emotion[2]]


1. Walker Brian R, Colledge Nicki R, Ralston Stuart H, Penman Ian D, Davidson’s  

Principles & Practice of Medicine. 22th Edition. Churchill Livingstone: Elsevier; 2014 

2. Boericke William. New Manual of Homoeopathic Materia Medica with Repertory. 3rd revised & Augmented Edition Based On 9th Edition. New Delhi, B. Jain Publisher(P)  

LTD: 2010 

3. Sarkar Sunirmal Dr. Compiled by Gaikwad Gaurang Dr. Just You Think- The Top  

Remedies for Various Disease conditions. Volume 2. Mumbai, Homoeopathic  

Medical Publishers: 2019

4. Morrison Roger. Desktop Guide: To Keynotes and Confirmatory Symptoms. 1st  edition. Hahnemann clinic pub; 1993 

5. Ralston, Stuart H., et al., editors. Davidson’s Principles and Practice of Medicine.  23rd ed., Elsevier Health Sciences, 2018. 

6. ties_of_Daily_Living_in_Ocular_Myasthenia_Gravis 

7. Gratton SM, Herro AM, Feuer WJ, Lam  BL. Cigarette Smoking and Activities of Daily Living in Ocular Myasthenia Gravis. J  Neuroophthalmol. 2016;36(1):37-40. doi:10.1097/WNO.0000000000000306


1. Dr. Devangi Pandya, MD (Hom), PG Guide, Prof., Repertory Dept., Alumni, CEP & G20 Co-ordinator, Ahmedabad Homoeopathic Medical College, Ahmedabad (Gujarat)

2. Dr. Prashant C Nuval, BHMS, MD (Organon), Ph.D. Scholar, Associate Prof., Organon Dept, Nootan Homoeopathic Medical College, Visnagar (Gujarat)

3. Dr. Saurav Vimalbhai Patel, BHMS, Pursuing MD (Hom), Ahmedabad Homoeopathic Medical College, Ahmedabad (Gujarat)

About the author

Dr. Devangi Pandya

Dr. Devangi Pandya, MD (Hom), PG Guide, Prof., Repertory Dept., Alumni, CEP & G20 Co-ordinator, Ahmedabad Homoeopathic Medical College, Ahmedabad (Gujarat)