Myasthenia Gravis

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Questions to Ask Your Doctor about Myasthenia Gravis
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Treatment

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
Anticholinesterase medications such as neostigmine (Prostigmin®) and pyridostigmine (Mestinon®) are usually prescribed. These drugs prevent ACh destruction and increase the accumulation of ACh at neuromuscular junctions, improving the ability of the muscles to contract.

Side effects include excessive salivation, involuntary muscle twitching (fasciculation), abdominal pain, nausea, and diarrhea. A drug called kaolin may be used with anticholinesterase medications to reduce gastrointestinal side effects.

Corticosteroids (e.g., prednisone) suppress the antibodies that block AChR at the neuromuscular junction and may be used in conjunction with anticholinesterase. Corticosteroids improve symptoms within a few weeks and once improvement stabilizes, the dose is slowly decreased.

A low dosage may be used indefinitely to treat MG; however, side effects such as gastric ulcers, osteoporosis (bone thinning), weight gain, high blood sugar (hyperglycemia), and increased risk for infection may develop over the long term.

Immunosuppressants such as azathioprine (Imuran®) and cyclophosphamide (Neosar®) are used to treat generalized MG when other medications fail to reduce symptoms. Side effects may be severe and include low white blood cell count (leukopenia), liver dysfunction, nausea, vomiting, and hair loss.

Immunosuppressants are not used to treat congenital MG because this condition is not the result of an immune system malfunction.

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