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Treatments and drugs
By Mayo Clinic staffDoctors use a variety of treatments, alone or in combination, to relieve symptoms of myasthenia gravis.
Medications
- Cholinesterase inhibitors. Drugs such as pyridostigmine (Mestinon) enhance communication between nerves and muscles. These drugs don't cure the underlying problem, but they do improve muscle contraction and muscle strength. Possible side effects may include gastrointestinal upset, excessive salivation and tearing, and frequent urination.
- Corticosteroids. These types of drugs 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, increased risk of some infections, and an increase and redistribution of body fat.
- Immunosuppressants. Your doctor may also prescribe other medications that alter your immune system, such as azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) or mycophenolate (CellCept). Side effects of immunosuppressants can be serious and may include increased risk of infection, liver damage, infertility and increased risk of cancer.
Therapy
- 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 are blocking transmission of signals from your nerve endings to your muscles' receptor sites. However, the beneficial effects usually last only a few weeks. Repeated treatments can lead to difficulty gaining access to a vein, which may require implanting a catheter, a long, flexible tube, into your chest. Another risk associated with plasmapheresis is a drop in blood pressure. Bleeding occasionally occurs because of the medications used to keep the blood from clotting during the procedure. It's also possible to develop an allergic reaction to the solutions used to replace the plasma or to the sterilizing agents used for the tubing.
- Intravenous immune globulin. This therapy provides your body with normal antibodies, which alters your immune system response. It has a lower risk of side effects than do plasmapheresis and immune-suppressing therapy, but it can take a week or two to start working, and the benefits usually last no more than a month or two. Side effects, which usually are mild, may include chills, dizziness, headaches and fluid retention.
Surgery
About 15 percent of the people who have myasthenia gravis have a tumor in their thymus, a gland under the breastbone that is involved with the immune system. If you have such a tumor, you'll need to have your thymus removed.
For people with myasthenia gravis who don't have a tumor in the thymus, it's unclear whether the potential benefit of removing the thymus outweighs the risks of surgery.
Surgery is not recommended by most doctors if:
- Your symptoms are mild
- Your symptoms involve only your eyes
- You're older than 60
- Myasthenia gravis fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm. Accessed July 6, 2010.
- Howard J.F. Myasthenia gravis — A summary. Myasthenia Gravis Foundation. http://www.myasthenia.org/hp_clinicaloverview.cfm. Accessed July 9, 2010.
- Bird SJ. Clinical manifestations of myasthenia gravis. http://www.uptodate.com/home/index.html. Accessed July 7, 2010.
- Bird SJ. Diagnosis of myasthenia gravis. http://www.uptodate.com/home/index.html. Accessed July 7, 2010.
- Bird SJ. Treatment of myasthenia gravis. http://www.uptodate.com/home/index.html. Accessed July 7, 2010.
- Facts about plasmapheresis. Muscular Dystrophy Association. http://www.mdausa.org/publications/fa-plasmaph.html. Accessed July 9, 2010.
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