The treatment of Myasthenia Gravis (MG) is divided into acute and chronic stages. Most patients with MG require daily, maintenance therapy and during exacerbations (i.e. acute worsening of symptoms) may require additional treatments.
Typically, treatment of MG involves a combination of the listed treatments.
Pyridostigmine and neostigmine are a class of medications called acetylcholinesterase inhibitors, typically taken every 4-6 hours, which treat just the symptoms associated with MG. As they are symptomatic treatments, they do not alter the long term course of the disease.
Steroids: The common one used is prednisone. It suppresses the immune system, can cause worsening of symptoms within the first 48 hours, and is a very effective disease modifying treatment for MG. It's use is limited by side effects.
Immunosuppressants (examples include azathioprine, mycophenolate mofetil, cyclosporin A, and cyclophosphamide) as their name implies suppress the immune system thus improving the course of the disease and providing for long term control of the symptoms of MG. Immunosuppressants are often used in conjunction with pyridostigmine and low dose steroids. They are used to minimize the dose of steroids necessary for control of symptoms, and thus minimize steroid side effects, however do come with their own side effects.
IVIG (intravenous immunoglobulin) is administered as an IV medication over 3-5 days and commonly used to treat exacerbations of MG symptoms parrticularly in the hospital setting. IVIG is thought to work by removing the antibodies that cause MG.
Plasmaphoresis is also used to treat exacerbations and works by filtering the blood and removing the antibodies that cause MG.
Lastly, depending on your age and the severity of the disease, thymectomy (removal of the thymus gland) is also an option.
More Answers from Darshan Shah, MD