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Treatments of Myasthenia Gravis (MG)
Although there is no cure yet, there are very effective treatments for Myasthenia Gravis. In our office most patients become asymptomatic with proper treatment. There are two general classes of medications. One class is aimed at increasing the amount of acetylcholine in the body and the other is aimed at suppressing the immune system.
The first class of medications is the anticholinesterase agents. They function by inhibiting the brake down of acetylcholine. Mestinon is one of the most widely used anticholinesterase agents for the treatment for Myasthenia Gravis. Mestinon allows acetylcholine to remain at the neuromuscular junction longer than usual so that more receptor sites can be activated resulting in a stronger muscle contraction and less weakness. Treatment with Mestinon causes most patients to have rapid signs of improvement. However, it is not a good option for chronic treatment in most patients because of the multiple problems that it could cause. High doses of Mestinon could be very dangerous as it could cause weakness, and it could have many side effects including nausea, vomiting, diarrhea, increased secretions, decreased heart rate, and others.
A very important point to understand is that Mestinon does not treat the underlying disease. As already mentioned Myasthenia Gravis is a disease where the body attacks the muscle receptors, and as long as the immune system is not inhibited, the disease progresses causing the patient to become progressively weaker. Patients notice that initially they require a small amount of Mestinon but with progression of disease, higher doses is required. Eventually Mestinon becomes ineffective or when the dose is raised high enough, Mestinon itself causes weakness, and the patient could develop Myasthenic crisis. It should be noted that there are cases where the severity of the disease is minimal, usually effecting the eyes only, and the disease does not progress; in these cases Mestinon could be a good treatment option.
Another accepted treatment for Myasthenia Gravis is Thymectomy, removal of the thymus gland. It is believed that removal of the thymus gland in younger patients could increase the probability of remission or cause improvement. Maximum benefit is generally seen within two to five years.
We are currently using multiple treatments for Myasthenia Gravis to suppress the immune system which include corticosteroids, like Prednisone, Azathioprine (Imuran), Cyclophosphamide (Cytoxan), Mycophenolate Mofetil (CellCept), Plasmapheresis, and Intravenous Immunoglobulin (IVIG). Each of these treatments has their benefits and side effects. In our clinic, we take into consideration each patient individually designing the best treatment plan for each patient. In most cases we are able to make the patients asymptomatic without major side effects.
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