Can I Drive With Myasthenia Gravis?
Myasthenia gravis is an autoimmune disease affecting the muscles. It leads to weakness and fatigue of the muscles without any pain preventing patients from performing daily tasks. It affects around 100-150 individuals per million. The distribution of the disorder is bimodal, affecting younger women twice than men; however, in older individuals this distribution is reversed. The average age of onset in females is 35 years and for males is 50 years.
Can I Drive With Myasthenia Gravis?
The diagnosis of myasthenia gravis does not prevent a person from driving, although, it is important to take necessary precautions. First of all, Driver and Vehicle Licensing Agency (DVLA) and car insurance company should be informed about the disease. DVLA will then evaluate the disorder and check the severity of Myasthenia gravis. Based on the evaluation, they can deem a person fit to drive, can temporarily prohibit a person from driving until his/her condition is managed with medications or treatment and then again re-evaluate a person for fitness or they can permanently prohibit a person from driving if the condition is severe enough.(3)
Driving is only permitted if a person is managing their condition with medical therapy. If at any moment their condition deteriorates they should inform their specialist along with DVLA. There are some recommendations that the drivers with myasthenia should keep in mind. These include, driving only during the day and avoiding driving at night when they are more tired. If during driving, they start having eye problems, such as double vision or drooping of eyelids, then they should immediately park the car to a side and ask for help. Avoiding driving in these situations can prevent accidents. (1)
Doctors should also inform the patient about the side-effects of medications, so that precautions can be taken while driving. In addition, they should also be informed about the possible interactions with some other medications, which include diazepam, phenothiazines, hydantoin, quinine and streptomycin. These medications can precipitate myasthenia gravis; therefore, these drugs should be avoided. In cases, the drugs are necessary; patients should be advised to refrain from driving.
Symptoms Of Myasthenia Gravis
Myasthenia gravis generally, leads to progressive weakness of affected muscles. Myasthenia gravis course is highly variable and can cause localized or generalized muscle weakness. It is mostly exacerbated by fatigue and the patient may feel worse by evening or night. The most commonly affected muscle groups in Myasthenia gravis are the eye muscles, bulbar muscles and skeletal muscles. It is important to note that there are no sensory losses in myasthenia gravis. In addition, muscles governed by autonomic nervous system, which include digestive, cardiac, and urinary musculature, are not affected by myasthenia gravis.
In more than 85% of the Myasthenia gravis patients, eye muscles are affected. In about 80% of these patients, other generalized muscle weakness occurs within 2 years of ocular symptoms. Myasthenia gravis starts by affecting this group of muscles and on occasions only ocular muscles will be affected. These muscles are more prone to fatigue, therefore, more commonly affected. The eye problems associated with myasthenia gravis include drooping of eyelids (upper and/or lower) known as ptosis in addition to double vision. (2)
Bulbar muscle weakness is seen in about 20% of the patients at the start of myasthenia gravis. These muscles are controlled by medulla (lower brain stem) and help in breathing, speech, swallowing and chewing. Difficulty and chewing and swallowing are more prominent at the end of a meal and these patients are at a greater risk of developing aspiration pneumonia. When breathing is affected, it can lead to respiratory failure.
The involvement of skeletal muscles can lead to weakness of any group of skeletal muscles causing problems performing day to day tasks. However, muscles closer to center of the body are more often affected. These muscles help in sitting upright, getting up from a chair and breathing.
Myasthenia gravis can also affect the ability to drive; therefore, a patient should be very cautious while driving.