Myasthenia gravis

Treatment

There is no known cure for myasthenia gravis. However, treatment may result in prolonged periods of remission.

Lifestyle adjustments may enable continuation of many activities. Activity should be planned to allow scheduled rest periods. An eye patch may be recommended if double vision is bothersome. Stress and excessive heat exposure should be avoided because they can worsen symptoms.

Some medications, such as neostigmine or pyridostigmine, improve the communication between the nerve and the muscle. Prednisone and other medications that suppress the immune response (such as azathioprine, cyclosporine, or mycophenolate mofetil) may be used if symptoms are severe and there is inadequate response to other medications.

Plasmapheresis, a technique in which blood plasma containing antibodies against the body is removed from the body and replaced with fluids (donated antibody-free plasma or other intravenous fluids), may reduce symptoms for up to 4 - 6 weeks and is often used to optimize conditions before surgery.

When other treatments do not improve systems, patients may receive intravenous immunoglobulin.

Surgical removal of the thymus (thymectomy) may result in permanent remission or less need for medicines.

Patients with eye problems may try lens prisms to improve vision. Surgery may also be performed on the eye muscles.

Several medications may make symptoms worse and should be avoided. Therefore, it is always important to check with your doctor about the safety of a medication before taking it.

Crisis situations, where muscle weakness involves the breathing muscles, may occur. These attacks seldom last longer than a few weeks. Hospitalization and assistance with breathing may be required during these attacks. Often plasmapheresis is used to help end the crisis.

Support Groups

The stress of illness can often be helped by joining support groups where members share common experiences and problems. See myasthenia gravis - support group.

Outlook (Prognosis)

There is no cure, but long-term remission is possible. There may be minimal restriction on activity in many cases. Patients that only have eye symptoms (ocular myasthenia gravis), may progress to have generalized myasthenia over time.

Pregnancy is possible for a woman with myasthenia gravis but should be closely supervised. The baby may be temporarily weak and require medications for a few weeks after birth but usually does not develop the disorder.

Possible Complications

• Restrictions on lifestyle (possible)
• Side effects of medications (see the specific medication)
• Complications of surgery
• Myasthenic crisis (breathing difficulty), may be life threatening

When to Contact a Medical Professional

Call your health care provider if symptoms suggesting myasthenia gravis occur.

Go to the emergency room or call the local emergency number (such as 911) if breathing difficulty or swallowing problems occur.

References

Benatar M, Kaminski HJ. Evidence report: the medical treatment of ocular myasthenia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;68(24):2144-9.

Zinman L, Ng E, Bril V. IV immunoglobulin in patients with myasthenia gravis: a randomized controlled trial. Neurology. 2007;68(11):837-41.

Goldman L ed. Cecil Texbook of Medicine, 23rd ed. Philadelphia, Pa: Saunders; 2007.