With treatment, myasthenia gravis can generally be controlled. A variety of therapies can help reduce and improve muscle weakness. Your neurologist will determine which treatment option is best for you based on the following factors:
AgeSeverity of your conditionLocation of muscles affectedOther existing medical conditions
Medications
Your doctor may prescribe the following medications to treat myasthenia gravis: Anticholinesterase agents such as neostigmine (Bloxiverz) and pyridostigmine (Mestinon) can help improve neuromuscular transmission and increase muscle strength. Possible side effects may include:
Gastrointestinal upsetNauseaExcessive salivation and sweating
Immunosuppressive drugs such as prednisone (Deltasone), azathioprine (Imuran), cyclosporine (Neoral), mycophenolate mofeti (Cellcept), and tacrolimus (Prograf) improve muscle strength by suppressing the production of abnormal antibodies. However, immunosuppressive medications can cause the serious side effects listed below, so your doctor may closely monitor you:
NauseaVomitingGastrointestinal upsetIncreased risk of infectionLiver damageKidney damage
Eculizumab (Soliris), a monoclonal antibody, can be used in patients who are anti-acetylcholine receptor (AchR) antibody positive and for whom previous immunosuppressive treatment didn’t work. Eculizumab can help relieve significant symptoms of myasthenia gravis, including difficulties seeing, walking, talking, swallowing, and breathing. Eculizumab is currently only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Prescribers must enroll in the program in order to prescribe the medication. Eculizumab’s black box warning notes that meningitis is a serious possibility in patients with myasthenia gravis who are treated with eculizumab. In most cases, patients should receive meningitis vaccines at least two weeks before being treated with eculizumab. (Even patients who may not be treated with eculizumab should ask their doctor if they need a meningitis vaccine.) Eculizumab should not be prescribed to patients who are being treated for serious meningococcal infections. Possible side effects include:
HypertensionHeadacheNasal inflammationMusculoskeletal pain, including back painAbdominal pain, nausea, vomiting, and diarrheaUpper respiratory infectionCoughUrinary tract infectionAnemiaPeripheral edema
Ravulizumab (Ultomiris) is also a monoclonal antibody now approved for people with generalized myasthenia gravis who are AChR antibody positive. It possesses similar side effects to eculizumab, and it is also only available through a REMS program. Efgartigimod (Vyvgart) is an immunoglobulin G (IgG) antibody approved for generalized myasthenia gravis who are AChR antibody positive. The most common side effects are:
Respiratory infectionsUrinary tract infectionsHeadaches
Surgery
According to the Mayo Clinic, about 15 percent of people with myasthenia gravis have a tumor in their thymus gland (known as a thymoma). About 70 percent of people with myasthenia gravis have thymic hyperplasia, which means an increase in the size of the thymus gland. Surgically removing the gland (called thymectomy) can reduce symptoms in some people and may even cure some by rebalancing their immune system. Even if you don’t have a tumor in the thymus gland, removing it may improve your myasthenia gravis symptoms and even allow you to stop taking medications. Take note, however, that it can take years to notice the benefits of a thymectomy, and in some cases people may never notice improvements. A thymectomy may be performed in the following ways: Open Surgery This involves the surgeon splitting your central breast bone to open your chest and remove your thymus gland. Minimally Invasive Surgery Minimally invasive procedures may be beneficial because of the following reasons:
Less blood lossLess painLower mortality ratesShorter hospital stays compared with open surgery
These types of thymectomy include the following: Video-Assisted Thymectomy involves the surgeons making a small incision in your neck and using a long thin camera and small instruments to see and remove the thymus gland through your neck. Another approach used is to make a few small incisions in the side of your chest. Then the surgeons use a video scope and small instruments to conduct the procedure and remove the thymus gland through these incisions. Robot-Assisted Thymectomy allows surgeons to make several small incisions in the side of your chest and remove the thymus gland using a robotic system, which includes a camera arm and mechanical arms.
Other Options
During extremely difficult times of weakness, the following therapies may be used: Plasmapheresis is a procedure in which serum containing the abnormal antibodies is removed from the blood while cells are replaced. High-dose intravenous immune globulin temporarily modifies the immune system by infusing antibodies from donated blood. Lifestyle Therapies The following may help you cope with symptoms of myasthenia gravis. Eating Strategy
Eat small meals throughout the day.Eat when you have good muscle strength.Slowly chew your food.Pause between bites of food.Eat soft foods.Avoid foods that require a lot of chewing, such as raw fruits or vegetable.
Safety Precautions
Install grab bars or railings in your home where needed.Keep your floors clean and clear of loose rugs.Clear leaves, snow, and other debris from sidewalks and driveways.If you are getting weaker or you are having difficulty walking, a gait assessment by a physical therapist is important to ensure you are using the appropriate equipment and to reduce risk of falls with injury.
Use Electric Appliances and Tools. An electric toothbrush, can opener, and other electrical tools can keep you from using too much energy. Wear an Eye Patch. If you have double vision, wearing an eye patch by alternating it on each eye can help when writing, reading, and watching TV. Plan Ahead. Arrange to do your chores and errands at times when you have the most energy. Rest when needed.
Prognosis of Myasthenia Gravis
Treatment for most people with myasthenia gravis can significantly improve muscle weakness so that you can lead a normal life. Some people may experience a time of remission where muscle weakness disappears and medications are no longer needed. In fact, this is the goal of thymectomy, which is the surgical removal of the thymus gland. According to the National Institute of Neurological Disorders and Stroke, about 50 percent of individuals who undergo this procedure may experience long-lasting and complete remission.
