Myasthenia Gravis Treatment

We like to offer the full range of myasthenia gravis treatments to our patients, both medical and surgical. The University of Maryland Medical Center is committed to find options that you're comfortable with while also giving you the best options available.

Medical Treatments

Symptom Management

Pyridostigmine is an anticholinesterase inhibitor that works at the neuromuscular junction (NMJ). It prevents the breakdown of acetylcholine. Thus it allows acetylcholine to bind to more muscle receptors and create muscle contractions. Pyridostigmine does not alter myasthenia gravis disease, but provides temporary symptom improvement.

Immunosuppression

Myasthenia gravis is an autoimmune disease. Immunosuppressant medications work to lower the immune system response in order to prevent the immune attack on the NMJ, thereby limiting muscle fatigue. Common immunosuppressive medications used in myasthenia gravis include: Prednisone, Azathioprine, and Mycophenolate Mofetil.

While on immunosuppressant medication, care should be taken to limit exposure to colds and flus. Vaccinations should be up to date, including the flu and pneumonia vaccines. Practice good hand washing. You may need to follow-up frequently with your health provider to monitor certain blood tests.

Intravenous Immune Globulin

IVIG is an intravenous medication given through a small, peripheral catheter. IVIG binds to the antibodies in your bloodstream and then is filtered out of the body by the kidneys. During the infusion your heart rate and blood pressure are monitored. This medication is used for emergency situations when you have difficulty breathing or swallowing.

Plasmapheresis

Plasmapheresis is a treatment that requires insertion of a large catheter. Your blood is then filtered through a machine to pull out proteins, which contain the antibodies. During the filtering process, your heart rate and blood pressure are monitored. This treatment is used for emergency situations when you have difficulty breathing or swallowing.

Surgical Treatments

Myasthenia gravis may be associated with various abnormalities of the thymus gland.

The thymus gland lies behind the breastbone and is an important part of the immune system in infancy and early childhood.

The relationship between the thymus gland and myasthenia gravis has led to the medical recommendation that the gland be removed (thymectomy). About 10 percent of myasthenia gravis patients have a tumor of the gland (thymoma) and are treated with surgical removal, or thymectomy, as well.

Since the 1940's, myasthenia gravis has been treated by thymectomy with most patients showing some improvement after 6 months to 1 year following surgery.

The degree of improvement after surgery is not predictable, but can be significant. Myasthenia gravis patients who experience more than minimal symptoms should consider thymectomy for treatment. University of Maryland thoracic surgeons offer four different surgical approaches for thymectomy, including some which are minimally invasive, to best meet our patients' needs.