Treatment of Myasthenia gravis

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Acetylcholine is broken down in the body by enzymes called cholinesterases. This action can be blocked by anticholinesterase drugs such as pyridostigmine. These drugs can control myasthenia in some patients but many others need additional treatment.

Surgical removal of the thymus gland (thymectomy) is performed in patients with a thymoma and can also help some other patients, especially those who develop myasthenia before the age of about 45.

Drugs such as prednisolone (a steroid) and azathioprine that suppress the immune system are often used in patients with disabling weakness, especially those who do not have, or fail to respond to, thymectomy.

When rapid improvement is needed, for example severe weakness causing breathing or swallowing problems, patients can be admitted to hospital for plasma exchange, which removes antibodies from the blood.

Another option is an infusion of intravenous immunoglobulin. The benefits of these emergency treatments last only for about six weeks.