Treatment Options

Management of MG varies according to the severity of the disease, the age of the patient, and the type of myasthenia the patient has. Your neurologist will work with you over time to determine the right treatment and dosage for you.

 

MEDICATIONS

Some medications improve neuromuscular transmission and increase muscle strength. Some medications suppress the production of abnormal antibodies. These medications must be used with careful medical follow-up because they may have major side effects.

 

CHOLINESTERASE INHIBITORS

The most common is Mestinon. Myasthenia Gravis is caused by a communication problem between nerves and muscles, and this group of drugs enhances this communication. These drugs can improve muscle contraction and strength.

Possible side effects:

  • Excessive salivation
  • Frequent urination

 

CIRTICOSTERIODS

These types of drugs inhibit the immune system, and limit antibody production.

Prolonged use can have severe side effects.

Possible side effects:

  • Weight gain
  • Diabetes
  • Increased risk of some infections
  • Redistribution of body fat
  • Bone thinning

 

IMMUNOSUPPRESANTS

These drugs also alter immune system, and include CellCept and Imuran.

Side effects include:

  • Risk of infection
  • Liver Damage
  • Infertility
  • Increased risk of cancer
  • Intravenous Immune Globin (IVIG)

This therapy provides your body with normal antibodies. It does have lower side effects than plamapheresis, but it can take a week or two to start working. The benefits of this type of therapy normally lasts a month or two. Side effects, which are normally mild, may include chills, dizziness, headache, and fluid retention. An extraordinary benefit of this process is that it does not require special equipment, and the usual dose is small, only 400mg per kilogram per day for five successive days. The mechanism of action remains unknown, and the process is very expensive.

 

PLASMAPHERESIS

This procedure uses a filtering process similar to dialysis. Your blood goes through a machine that removes the antibodies that are causing the blocking of the signal from the nerve endings to the muscles. The benefits of this treatment only last a few weeks. Repeated treatments can lead to difficulty gaining access to a vein, which may cause the implementation of a catheter into your chest.

The procedure usually entails five exchange treatments of 3 to 4 liters each and carried out over a two-week period. Plasmapheresis is used primarily to stabilize the condition of patients in myasthenic crisis or for the short-term treatment of patients undergoing tymectomy.

For those rare cases that other methods of treatment do not work, plasmapheresis can be used as long-term therapy. Some negative aspects of plasmapheresis include problems with venous access, risk of infection of the indwelling catheter, hypotensions, and pulmonary embolism.

 

THYMECTOMY

The surgical removal of the thymus gland (which often is abnormal in myasthenia gravis patients) improves symptoms in certain patients and may cure some individuals, possibly by re-balancing the immune system. Most neurologists encourage thymectomy for patients with generalized MG without thymoma. Other factors influencing the decision include age, duration and severity of the disease, and response to medication. Although no adverse effects have been reported as a consequence of thymectomy in children, it is preferable to delay the surgery until puberty if possible because of the established role of the thymus in development of the immune system. Also, although thymectomy has been advocated for elderly MG patients, there is uncertainty about the persistence of thymic tissue in such patients after the age of 60.

The goal of thymectomy as a treatment for myasthenia gravis is to induce remission, or at least improvement, permitting a reduction in immunosuppressive medication. The mechanism by which thymectomy produces benefits in myasthenia gravis is still uncertain. In general, acetylcholine receptor-antibody levels fall after thymectomy, although there are conflicting reports. On theoretical grounds, there are several possible mechanisms. First, removal of the thymus may eliminate a source of continue antigenic stimulation. If the thymic myoid cells are the source of autoantigen then their removal might allow the immune response to subside. Second, thymectomy may remove a reservoir of B cells that are secreting acetylcholine-receptor antibody. This, thymectomy may correct a disturbance of immune regulation in myasthenia gravis.