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June 3, 2021
5 min. read

Myasthenia Gravis: Top Medications and Treatment Options

Medly

Myasthenia gravis is a neuromuscular disorder which was first documented in 1672 by Oxford Physician Thomas Willis. If you have this disease, you tend to grow weaker throughout the day, the more activities that you perform. Even simple movements can cause fatigue. The disorder usually affects the face, particularly the eyes. However, since the disease is neuromuscular, the disease can affect other parts of the body, too. Myasthenia gravis is hard to diagnose.

Doctors typically will need to perform numerous tests to diagnose the disease. These tests may include blood tests, nerve tests, muscle tests, and imaging tests.

What is Myasthenia Gravis?

The literal meaning of myasthenia gravis is “grave muscular weakness.” This debilitating autoimmune disease occurs when the immune system attacks the body’s muscle tissues without cause. Myasthenia gravis tends to strike in women under 40 years old and in men over the age of 60.

What is Myasthenia Gravis

If you suffer from this disease, you’ll feel lethargic throughout the day, particularly after exerting physical energy. Rest usually will allow you to return to normal activities. Another common symptom of the disease is drooping of the eyelids, known as ocular myasthenia gravis.

Other myasthenia gravis symptoms include:

  • Problems with speech
  • Trouble swallowing
  • Difficulty chewing
  • Uncontrollable facial expressions
  • Double vision
  • Inability to hold up your head
  • Trouble using your arms and hands

About 10 percent of patients tend to feel limb weakness at the onset of the disease. 15 percent usually feel the first symptoms of the disease in their face or throat muscles. Should you feel any of the symptoms listed above, you should consult a doctor for a diagnosis.

What are the causes of Myasthenia Gravis?

The disease tends to develop unexpectedly in patients. Most individuals have no family history of the disease, but there may be a genetic predisposition towards it. With Myasthenia Gravis, nerve impulses transmit erroneously, breaking down communication between the nerves and the muscle tissue attached to the nerves.

Neurotransmitters, called acetylcholine, typically bind to receptors on the muscle. However, with Myasthenia Gravis, antibodies block the receptors. As a result, this prevents the muscles from contracting, creating the weakness you may experience.

Scientists believe that the root causes of myasthenia gravis may have something to do with the thymus gland. It is instrumental in making T-lymphocytes which regulate the immune response by killing infected cells and activating immune cells. This is how the body usually fights off disease and viruses.

causes of Myasthenia Gravis

The thymus gland is large throughout childhood. However, in adults, the gland shrinks in size. If you suffer from Myasthenia Gravis, your thymus gland may be enlarged and filled with malignant tumors, which can become cancerous. Scientists believe that the enlarged thymus gland is responsible for the attack on neurotransmitters.

Top Treatments for Myasthenia Gravis

Presently there is no cure for this disease. However, some myasthenia gravis treatments minimize the effects of the disease. A monoclonal antibody is a standard treatment used for Myasthenia Gravis. This treatment aims to minimize the damage done by acetylcholine antibodies. The FDA (Food and Drug Administration) approved eculizumab for treatment in adults who test positive for the antiacetylcholine receptor antibody. Another treatment is the use of anticholinesterase medications. This improves muscle strength by minimizing the breakdown of acetylcholine.

Surgery Another way that doctors may treat myasthenia gravis is by surgery. Thymectomy is an operation to remove the thymus gland to help rebalance the immune system. Surgeons may perform one of three surgical techniques: transsternal, transcervical, or videoscopic. During transsternal surgery, the surgeon removes the thymus and fat from the center of the chest. This procedure is usually performed on patients who have Thymoma, a tumor in the thymus.

In patients who do not have Thymoma, surgeons use the transcervical technique. This technique removes the thymus through an incision made in the lower neck. Surgeons may use a videoscopic technique in conjunction with robotics to remove the thymus. This technique is like the transsternal technique but minimally invasive.

patient provider

Intravenous therapy The following therapies are usually used in the short term to treat a sudden worsening of symptoms or before surgery or other therapies.

  • Plasmapheresis (plaz-muh-fuh-REE-sis). This procedure uses a filtering process similar to dialysis. Your blood is routed through a machine that removes the antibodies that block transmission of signals from your nerve endings to your muscles' receptor sites. However, the good effects usually last only a few weeks, and repeated procedures can lead to difficulty accessing veins for the treatment.
  • Risks associated with plasmapheresis include a drop in blood pressure, bleeding, heart rhythm problems or muscle cramps. Some people develop an allergic reaction to the solutions used to replace the plasma.
  • Intravenous immunoglobulin (IVIg). This therapy provides your body with normal antibodies, which alters your immune system response. Benefits are usually seen in less than a week and can last three to six weeks.
  • Side effects, which usually are mild, can include chills, dizziness, headaches and fluid retention.
  • Monoclonal antibody. Rituximab (Rituxan) and the more recently approved eculizumab (Soliris) are intravenous medications used in some cases of myasthenia gravis. These drugs are usually used for people who don't respond to other treatments. They can have serious side effects.

Treatments for Myasthenia Gravis

Medications

  • Cholinesterase inhibitors. Medications such as pyridostigmine (Mestinon, Regonal) and neostigmine (Bloxiverz) enhance communication between nerves and muscles. These medications aren't a cure, but they can improve muscle contraction and muscle strength in some people. Possible side effects include gastrointestinal upset, diarrhea, nausea, and excessive salivation and sweating.
  • Corticosteroids. Corticosteroids such as prednisone inhibit the immune system, limiting antibody production. Prolonged use of corticosteroids, however, can lead to serious side effects, such as bone thinning, weight gain, diabetes and increased risk of some infections.
  • Immunosuppressants. Your doctor might also prescribe other medications that alter your immune system, such as azathioprine (Azasan,, Imuran) mycophenolate mofetil (Cellcept), cyclosporine (Sandimmune) methotrexate (Trexall) or tacrolimus (Astrograf XL, Prograf). These drugs, which can take months to work, might be used with corticosteroids. Side effects of immunosuppressants, such as increased risk of infection and liver or kidney damage, can be serious.

The use of these immunosuppressive drugs requires many months of use to be effective. Moreover, doctors must monitor patients using these medications. Consequently, over the long term, these medications may cause adverse effects.

Even though there’s no cure for the disease, treatment options can help reduce the difficulties associated with it. For instance, medications can improve your muscle movement, allowing you to experience greater mobility and less fatigue. Surgery and therapy can also help to improve your overall well-being.

References Myasthenia gravis (MG) What's to know about myasthenia gravis? Myasthenia gravis Facts Myasthenia Gravis Facts 2 Myasthenia gravis Fact Sheet Prednisone Azathioprine CellCept (Mycophenolate Mofetil) Prograf (tacrolimus) Thymectomy for Myasthenia Gravis

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