What's the treatment for myasthenia gravis?
Myasthenia gravis is one of the most treatable neuromuscular disorders. The choice of treatment depends on several factors, including age, overall health, severity of disease, and rate of disease progression.
Medications that improve symptoms of myasthenia gravis work by allowing more acetylcholine to accumulate in the neuromuscular junction. This increases the chances that receptors will be activated, so that the nerves and the muscles will have better communication and the muscles won't weaken as quickly. Pyridostigmine (Mestinon) is the most commonly prescribed medication for this condition. Drugs that suppress the immune system, such as corticosteroids and azathioprine (Imuran), work for some people, probably by reducing the amount of receptor antibodies in the body.
Thymectomy, the surgical removal of the thymus gland (which is abnormal in myasthenia gravis patients), improves symptoms in more than 50 percent of patients without thymoma and may cure some individuals, possibly by re-balancing the immune system. Other therapies used to treat myasthenia gravis include plasmapheresis, a procedure in which abnormal antibodies are removed from the blood, and high-dose intravenous immune globulin, which temporarily modifies the immune system and provides the body with normal antibodies from donated blood. These therapies may be used to help individuals during especially difficult periods of weakness. A neurologist, along with the primary care physician, will determine which treatment option is best for each individual depending on the severity of the weakness, which muscles are affected, and the individual's age and other associated medical problems.
Plasmapheresis is a process in which plasma is separated from the blood, cleansed of abnormal antibodies, and then replaced. Plasmapheresis can increase muscle strength for many people with myasthenia gravis, perhaps because it lowers the amount of abnormal antibodies. The technique is used mainly in severe cases that may be life threatening.
People with weakness of the bulbar muscles may need to eat softer foods that are easier to chew and swallow. In more severe cases, it may be necessary to obtain nutrition through a feeding tube placed into the stomach (gastrostomy tube).