In most cases, myasthenia gravis can be effectively treated and patients can lead normal or nearly normal lives. There are many treatments for myasthenia gravis. Which treatments are used depends somewhat on the severity of the disorder and which muscles are affected. The patient's age and other medical problems also affect treatment decisions. The following treatments may be part of a patient's treatment program. Your doctor will help you find the treatment regimen that works best for you.

There are several types of medications used to treat myasthenia gravis. In some cases, only one type of medication may be used. In others, different types of medications may be used together. The medications include cholinesterase inhibitors, prednisone, immunosuppressant agents, and IVIg.

Cholinesterase inhibitors include pyridostigmine bromide (Mestinon), neostigmine (Prostigmin), and ambenonium (Mytelase). These drugs work by blocking the enzyme that breaks down acetylcholine, a chemical messenger that triggers muscle contractions. When acetylcholine is not broken down as quickly, there is more of that chemical to bind to the receptors on the muscles. The increased binding reduces muscle weakness.

Prednisone (Deltasone, Orasone) is a corticosteroid. This is a synthetic hormone that suppresses actions of the immune system. For patients with myasthenia gravis, fewer antibodies to the acetylcholine receptor are produced when the immune system is suppressed.

Immunosuppresant agents include azathioprine (Imuran), cyclophosphamide (Cytoxan), and cyclosporine (Sandimmune, Neoral). These drugs suppress the activity of the immune system.

IVIg is pooled human gamma globulin. IVIg decreases the production of antibodies but the method by which it works is unknown.

A thymectomy is the surgical removal of the thymus gland. The thymus gland lies behind the sternum or breastbone. The thymus is a part of the immune system and its removal may ease symptoms of myasthenia gravis. However, its exact role in the disorder is still not understood.

Plasmapheresis is a process that removes acetylcholine receptor antibodies from the blood. During this procedure, the patient's blood is filtered through a special machine. As the blood is filtered, the patient's red blood cells are collected and mixed with artificial plasma. (Plasma is the liquid portion of the blood.) The mixture is then returned to the patient's body.

Everyone needs proper nutrition. This is especially true for patients with myasthenia gravis. The mineral potassium is necessary for muscle contraction and nerve impulse conduction, so diets rich in the mineral potassium are sometimes helpful in managing the symptoms of myasthenia gravis. Potassium is found in high concentrations in bananas, prunes, potatoes, raw spinach, meats, milk, tomatoes, cantaloupe, lettuce, cauliflower, apricots, and oranges.

Physical stress can worsen the symptoms of myasthenia gravis. In general, patients are advised to avoid extreme heat or cold and overwork. Schedules that allow rest periods help many patients manage symptoms.

Emotional stress can also worsen symptoms. Many patients benefit from stress management programs. These programs include progressive relaxation, meditation, visualization, and time management. Support groups can also help patients and their families cope with myasthenia gravis. Among other things, they can provide a means of learning more about the disorder.

References

First published April 1, 2000
Last updated November 25, 2002
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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