# Long-Term Swallowing Rehabilitation for Muscle-Specific Tyrosine Kinase Antibody-Positive Myasthenia Gravis: A Case Report

## TL;DR

A patient with a rare autoimmune disease improved swallowing after a year of intensive rehabilitation alongside medical treatment.

## Contribution

Demonstrates the effectiveness of long-term swallowing rehabilitation in a MuSK-MG patient with severe dysphagia.

## Key findings

- The patient achieved oral intake without myasthenic crisis or aspiration pneumonia after 12 months of rehabilitation.
- Combining rehabilitation with drug therapy improved swallowing function in a MuSK-MG case with persistent dysphagia.
- Intensive rehabilitation included muscle-strengthening exercises and sensory stimulation to address swallowing deficits.

## Abstract

Muscle-specific tyrosine kinase antibody-positive myasthenia gravis (MuSK-MG) often presents with severe dysphagia. However, effective strategies for swallowing rehabilitation in these patients have not been well established. We report a case of a MuSK-MG patient with severe dysphagia who underwent swallowing rehabilitation for approximately 12 months alongside drug therapy and showed improvement in swallowing function. The patient was a 67-year-old woman treated with high-dose intravenous methylprednisolone pulse therapy, high-dose intravenous immunoglobulin, and plasma exchange (PE) therapy. She required ventilator management and tracheotomy. The patient subsequently developed recurrent pneumonia, and rituximab was administered due to a poor response to previous treatments. Although the primary disease had apparently stabilized, the patient continued to experience severe dysphagia with silent aspiration, delayed swallowing reflexes, and pharyngeal residues. To address these issues, intensive and prolonged swallowing rehabilitation was implemented, including regular swallowing assessments, progressive muscle-strengthening exercises with controlled load levels, and interferential current stimulation to address sensory disturbances. Consequently, the patient successfully achieved oral intake without experiencing a myasthenic crisis or recurrence of aspiration pneumonia. These findings suggest that long-term swallowing rehabilitation, combined with appropriate treatment of the underlying disease, may effectively improve swallowing function in patients with MuSK-MG and persistent severe dysphagia.