Treatment for MG

There are many effective treatments for myasthenia gravis. Spontaneous improvement and even remission (although uncommon) may occur without specific therapy.

Anti-acetylcholinesterase agents (e.g., Mestinon®) allow acetylcholine to remain at the neuromuscular junction longer than usual so that more receptor sites can be activated.

Corticosteroids (e.g., prednisone) and immunosuppressant agents (e.g., Imuran®) may be used to suppress the abnormal action of the immune system that occurs in MG. Thymectomy (surgical removal of the thymus gland) is another treatment used in some patients. The thymus gland lies behind the breastbone and is an important part of the immune system. When there is a tumor of the thymus gland (in 10-15% of patients with MG), it is always removed because of the risk of malignancy. Thymectomy may lessen the severity of the MG weakness after some months to years. In some people the weakness may completely disappear. This is called a remission. The degree to which the thymectomy helps varies with each patient.

Plasmapheresis, or plasma exchange, may be useful in the treatment of MG also. This procedure removes the abnormal antibodies from the plasma of the blood. The improvement in muscle strength may be striking, but is usually short-lived, since production of the abnormal antibodies continues. When plasmapheresis is used, it may require repeated exchanges. Plasmapheresis may be especially useful during severe MG weakness or prior to surgery.

Intravenous immune globulins (IVIg) are sometimes used to affect the function or production of the abnormal antibodies also.

Newer treatments with monoclonal antibodies (rituximab, eculizumab) are under active clinical trials and may be available in the near future as another tool in the treatment of MG.

Treatment decisions are based on knowledge of the natural history of MG in each patient and the predicted response to a specific form of therapy. Treatment goals are individualized according to the severity of the MG weakness, the patient’s age and sex, and the degree of impairment.

While there are medical treatments in place for MG, there are still day to day issues dealing with MG
What are your strategies?