Myasthenia Gravis: A Review of Available Treatment Approaches

Abstract

Patients with autoimmune myasthenia gravis (MG) should be further classified before initiating therapy, as treatment response varies for ocular versus generalised, early onset versus late onset, and acetylcholine receptor antibody positive versus MuSK antibody positive disease. Most patients need immunosuppression in addition to symptomatic therapy. Prednisolone and azathioprine represent first choice drugs, whereas several second choice options are recommended and should be considered. Thymectomy should be undertaken in MG with thymoma and in generalised, early-onset MG. For MG crises and other acute exacerbations, intravenous immunoglobulin (IvIg) and plasma exchange are equally effective and safe treatments. Children and females in child bearing age need special attention regarding potential side effects of immunosuppressive therapy. MG pathogenesis is known in detail, but the immune therapy is still surprisingly unspecific, without a pin-pointed attack on the defined disease-inducing antigen-antibody reaction being available.

Risk Factors and Outcomes in Cats with Acquired Myasthenia Gravis (2001–2012)

“…In both the human and veterinary literature, there are conflicting reports of continued clinical signs of MG versus remission of clinical signs after surgical removal of thymoma 7, 11, 12, 25, 26, 27, 28, 29, 30, 31, 32, 33. Studies in myasthenic people include both cases of thymic hyperplasia and thymoma.…”

Obravnava novoodkritih bolnikov z miastenijo gravis v regionalni bolnišnici med leti 2003–2013

“…Prizadene bolnike vseh ras in obeh spolov. Lahko se začne v kateri koli starosti, vendar je pri belcih predvsem bolezen odraslih (v 85-90 % obolevajo ženske med 20. in 40. letom starosti ter moški po 50. letu starosti; v otroštvu zboli le 10-15 % vseh bolnikov) (2,3).…”

“…Napoved izida bolnikov z MG se je dodatno izboljšala v 50. letih prejšnje-ga stoletja, ko so bolezen pričeli zdraviti z imunosupresivnimi zdravili, miastensko krizo pa obvladovati s podpornim umetnim predihavanjem in drugimi oblikami invazivnega zdravljenja. Smrtnost in življenjska doba bolnikov z MG sta tako postali primerljivi s smrtnostjo in ži-vljenjsko dobo splošne populacije (3).…”

Successful Use of Rocuronium and Sugammadex in a Patient with Myasthenia Gravis Undergoing Cervical Anterior Fusion: A Case Report

“…Myasthenia gravis (MG) is an autoimmune disorder caused by failure of transmission of the neuromuscular junction leads to an unpredictable response to neuromuscular blockers, which is twice common in women than men [1][2][3]. MG is characterized by weakness and fatigue of skeletal muscle that it worsens with repetitive exercise while it improves with restore after administration of anticholinesterase medication [4,5].…”