Myasthenia gravis (MG) can be treated with drugs, surgery and other therapies – alone or in combination. What’s right for you depends on the severity of your disease, which muscles are affected, your age, and the presence of other medical problems. Show MG treatment also includes self-care: getting plenty of sleep, resting your eyes, pacing your activity, eating healthy foods, exercising, and managing your stress. Below is a discussion of various treatments. For here for more information about rescue and maintenance therapies (from 2019 presentation by Ryan Jacobson, MD, Rush University. Click here for the presentation video. MedicationsThere are two types of medications used to treat MG. One group—anticholinesterases—temporarily relieves the symptoms of MG. Another group—immunosuppressants—attacks the disease at its source. By suppressing the body’s immune system, these drugs stop the body from damaging the neuromuscular junction in the first place. Immunosuppressant treatments can have serious side effects. Doctors may prescribe one or a combination of these medications. It often takes time to determine the best medication and dosage for an individual patient. Anticholinesterase MedicationThis is typically the first type of medication prescribed because it is has the fewest long-term side effects. It also is the most rapid-acting medication available. These drugs prevent the breakdown of acetylcholine—the chemical messenger that causes a muscle contraction. More acetylcholine generally results in greater muscle strength. Although anticholinesterase medication does not directly counteract the abnormal immune system attack in MG, they may partially or completely control MG symptoms in some patients. The most commonly prescribed medication of this type is pyridostigmine bromide (Mestinon). It’s available in tablet or liquid, and comes in a time-release form. The different forms vary in how soon and how long they’re effective. Acetylcholinesterases can cause stomach cramps and diarrhea; it helps to take them with bland food like crackers, applesauce or yogurt. Other common side effects include muscle twitching, muscle cramps and sweatiness. Sometimes these symptoms appear when too much medication is taken. If you have these symptoms, you should talk with your doctor to see if you should reduce your dose or vary when you take the medication. Immunosuppressant MedicationsImmunosuppressants help prevent your body from producing the harmful antibodies that cause MG weakness in the first place. At the same time, they also reduce the body’s production of good antibodies—which makes you more susceptible to infection and other diseases. While you’re taking immunosuppressants, it’s important to avoid people with contagious diseases. You may need to avoid crowds and wash your hands often. The use of these medications must be monitored carefully by a physician because they may cause major side effects.
ThymectomyA thymectomy is the surgical removal of the thymus gland. The thymus—located in the upper chest behind the breast bone—plays an important role in the development of the immune system and is abnormal in about half of individuals with MG. Some individuals develop thymomas or tumors on the thymus gland. Generally thymomas are benign, but in rare cases they can become malignant. Doctors recommend thymectomies for individuals with thymomas, and for most patients under age 60 with moderate to severe generalized myasthenia. According to the National Institute of Neurological Disorders and Stroke, surgery reduces MG symptoms and may cure some people, possibly by re-balancing the immune system. This improvement, however, is unpredictable and may take several months or several years after surgery to occur. Recently-developed methods to remove the thymus gland have resulted in fewer complications and shorter recovery from the procedure. Hear from an ExpertWatch Drs. Rowin, Meriggioli, Abdelhady and Giulianoti discuss MG treatments and thymectomy approaches. Purchase full-length DVD “Medical Management of MG/Thymectomy – Various Surgical Approaches“. Intravenous Immune Globulin (IVIg)Immune globulin therapy can be used to treat rapidly worsening MG. Immune globulin is a human blood product pooled from multiple donors who are carefully screened. By providing the body with normal antibodies from donated blood, IVIg treatments appear to temporarily modify the immune system. For most individuals, MG weakness typically improves within a week of treatment and lasts for several weeks or months. IVIg treatments are expensive and offer short-term relief from MG symptoms until longer acting immune modifying treatments are effective. Side effects—for instance, headache or allergic symptoms–are usually related to how fast the drug is administered. Slowing the infusion rate can help with this. IVIg infusions are sometimes repeated at monthly intervals to sustain the treatment effect. PlasmapheresisPlasmapheresis, or “plasma exchange,” is a procedure that removes antibodies—both “bad” and “good”—from the blood. Over several hours, blood is gradually removed through a special intravenous line, plasma which contains antibodies is separated off, and then the antibody-free blood is returned to the body along with a blood product called albumin to replace some of the proteins lost in the procedure. This treatment doesn’t affect the body’s ability to make more antibodies, and so the relief it provides is generally temporary. It also is expensive. Plasmapheresis is used for patients who have severe MG symptoms, or who need to improve strength before surgery. It’s also used periodically for those who don’t respond to other treatments. With plasma exchange, an individual typically gets stronger in several days; the treatment benefit usually lasts two to three weeks. Since the effects are often short-term, a series of treatments over a period of two weeks is usually necessary. Plasmapheresis involves removing large volumes of blood, which can lower the blood pressure and lead to dizziness or near-fainting. Allergic reactions – from fever, chills, and rash, to serious drops in blood pressure – may occur when donor blood products or plasma are given to the patient. This also may occur with administration of IV immune globulin (see above). Supplemental TherapiesMG can be fought with traditional medicine. But how else can you take a measure of control over your illness?
This information was abstracted from these sources: Sunders, et. al., International consensus guidance for management of myasthenia gravis. Neurology 2016;87:1-7. Howard et. al., Safety and efficacy of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis (REGAIN): a phase 3, randomised, double-blind, placebo-controlled, multicentre study. Lancet Neurology 2017, Dec; 16(12):976-986 Jeffrey M. Statland and Emma Ciafaloni, Myasthenia gravis: Five new things, Neurol Clin Pract 2013; 3;126-133. Richman DP and Agius MA, Treatment of autoimmune myasthenia gravis, Neurology 2003 Dec 23; 61(12):1652-61. The Practical Guide to Myasthenia Gravis by John C. Keesey, M.D. and Rena Sonshine (published 2012 by the Myasthenia Gravis Foundation of California. The Myasthenia Gravis Fact Sheet published by the National Institute of Neurological Disorders (updated February 19, 2016) and retrieved April 27, 2016. Nils Erik Gilhus, Advances in the Treatment of Myasthenia Gravis, Future Neurology, 2012; 7(6):701-708. Díaz-Manera J1, et al., Long-lasting treatment effect of rituximab in MuSK myasthenia, Neurology. 2012 Jan 17;78(3):189-93. Zebardast N.. al., Rituximab in the management of refractory myasthenia gravis, Muscle Nerve. 2010 Mar;41(3):375-8. Information about MG treatments is of a general nature. It is not intended to be medical opinion, nor is it a substitute for personal professional medical care. Information about supplemental therapies is of a general nature, composed by non-medical personnel. It is meant to be accurate and helpful advice for MG patients. It is not intended to be medical opinion, nor is it a substitute for personal professional medical care. What drug is used to diagnose myasthenia gravis?Edrophonium is a medication used in the diagnosis of myasthenia gravis. It is in the acetylcholinesterase class of drugs.
Why is Edrophonium used to diagnose myasthenia gravis?Edrophonium is a rapid-acting anticholinesterase drug of short duration that improves symptoms of myasthenia gravis by inhibiting the breakdown of ACh and increasing its concentration in the neuromuscular junction.
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