Treatment Options for Myasthenia Gravis

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder that affects muscle strength and control. Fortunately, several effective treatment approaches are available, including medication therapy, thymus-related interventions, plasma exchange, and intravenous immunoglobulin therapy. These methods aim to manage symptoms, improve quality of life, and in some cases, achieve long-term remission.

Medication Therapy

Cholinesterase inhibitors are often the first-line treatment for symptom relief. Pyridostigmine bromide is the most commonly prescribed drug in this category. Adults typically take 60–120 mg three to four times daily, ideally 30 minutes before meals. Neostigmine bromide is another option, with a recommended dosage of 15–30 mg taken three to four times a day, offering effects that last about 3–4 hours. Like pyridostigmine, it should also be taken before meals to optimize muscle function.

Corticosteroids play a key role in suppressing the immune system's abnormal response in MG patients. They are effective across all types of myasthenia gravis. However, some individuals may experience temporary worsening of symptoms, including the risk of myasthenic crisis, when starting high-dose steroid therapy. For this reason, hospitalization is often required during initial treatment to ensure patient safety and provide immediate medical support if needed.

Immunosuppressants are typically used for patients who do not respond well to corticosteroids or experience significant side effects. Although these medications may carry potential risks, low-dose regimens are generally well tolerated. Common side effects include gastrointestinal discomfort, hair loss, reduced platelet count, and in rare cases, hemorrhagic cystitis, particularly with drugs like azathioprine or cyclophosphamide. Regular monitoring of liver and kidney function is essential during treatment to ensure safety and adjust dosing as needed.

Thymus-Related Treatment

Thymectomy, or surgical removal of the thymus gland, is often recommended for patients with thymoma (a tumor of the thymus) or thymic hyperplasia. It may also benefit individuals whose symptoms are difficult to control with medication alone. However, this procedure is generally not recommended for patients under the age of 18 who do not have a thymic tumor, significant thymic enlargement, or severe symptoms. The decision to perform a thymectomy should be made on a case-by-case basis, considering both the potential benefits and surgical risks.

Plasma Exchange (Plasmapheresis)

Plasma exchange is a procedure that removes harmful antibodies and immune complexes from the blood by replacing the patient's plasma with donor plasma or synthetic substitutes. This therapy offers rapid symptom improvement and is especially useful in acute or severe cases. However, the effects are usually temporary, lasting only a few weeks. Due to the specialized equipment and expertise required, not all medical centers are equipped to perform plasma exchange. It is often used as a short-term solution while long-term therapies take effect.

Intravenous Immunoglobulin (IVIG)

In recent years, high-dose intravenous immunoglobulin has emerged as a valuable treatment option for myasthenia gravis. IVIG works by modulating the immune system and reducing the harmful autoimmune response. It is particularly beneficial during disease flare-ups or prior to surgery. The treatment is generally well tolerated, with effects typically seen within a few days to a week. IVIG offers a safer alternative for patients who cannot undergo plasma exchange or tolerate other immunosuppressive therapies.