Myasthenia gravis - Treating myasthenia gravis

There is no cure for myasthenia gravis, but treatments are available to help control the symptoms.

In many cases, treatment for myasthenia gravis can significantly improve muscle weakness and a person with the condition is able to lead a relatively normal life.

If your symptoms are mild, you may find that getting plenty of rest helps improve your symptoms without the need for additional treatment.

Medication

Medications such as pyridostigmine, and less commonly neostigmine, can be prescribed for myasthenia gravis. They prevent the breakdown of acetylcholine, an important chemical that helps the muscles contract (tighten).

These medicines tend to work best in cases of mild myasthenia gravis. They can improve muscle contractions and strength in the affected muscles. They are often used as the first line of treatment for myasthenia gravis if the initial symptoms are not too severe.

However, they can sometimes cause side effects, such as stomach cramps, muscle twitching, diarrhoea and nausea. Your doctor will be able to prescribe additional medication for you if you experience these.

Steroid tablets, such as prednisolone, are used if the symptoms of myasthenia gravis worsen despite using pyridostigmine. Initially, these steroid tablets are usually given in hospital and the dose is quickly increased to a high level.

At the same time, doctors often prescribe additional medication that suppresses the immune system, such as azathioprine, methotrexate or mycophenolate.

It is hoped that these tablets will act alongside the steroids to reduce the level of harmful antibodies. Doctors may allow the steroid dose to be reduced over time, but probably not within the first four to six months.

Regular blood monitoring is required for all people taking these immunosuppressants. All of these medications have associated side effects that your doctors will discuss with you.

Some people respond well and are able to stop using all steroids in remission, while continuing to take secondary immunosuppressant medication. In time (usually years), it may be possible to stop all immunosuppressant medication if you remain well.

Thymectomy

In some cases of myasthenia gravis, surgery to remove the thymus gland (a thymectomy) may be recommended.

Thymectomy can improve the symptoms of people who do not have tumours (thymomas) on their thymus gland. It is thought that the immune system rebalances itself after the thymus gland is removed.

However, the improvement may take some time to occur. It is usually seen within the first year, although in some cases it can take up to three years.

Thymectomies are usually only recommended for people under 60 years of age, although research is ongoing to establish exactly which non-thymoma myasthenia gravis patients benefit from this type of surgery.

Plasmapheresis and immunoglobulin therapy

Plasmapheresis or intravenous immunoglobulin therapy may be needed in very severe cases of myasthenia gravis, where a person has such severe muscle weakness that it is causing life-threatening breathing or swallowing problems.

These treatments are given in hospital and involve:

• plasmapheresis, where your blood is circulated through a machine that removes the plasma containing the harmful antibodies
• intravenous immunoglobulin therapy, where you are injected with normal antibodies from donated blood that temporarily change the way your immune system operates 

Both treatments can produce a rapid improvement in the symptoms of myasthenia gravis, but the benefits usually only last a few weeks. They are therefore not suitable as long-term treatments for myasthenia gravis, and are usually only used to treat people who are seriously ill.