Management of MG: Introduction
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Myasthenia Gravis is an autoimmune disease in which the lymphocytes in
the blood produce antibodies that destroy muscle-cell sites for the reception
of acetylcholine molecules. Normally, acetylcholine is used in signal transmission
between nerves and muscles, its ultimate goal is to provide for muscle contractions.
Therefore, in myasthenia gravis, in which acetylcholine receptors are destroyed,
muscle contractions cannot be initiated.
No cure for myasthenia gravis has been found. Therefore, the next concern
would be to decrease or eliminate the symptoms that accompany the disease.
The outlook for patients with myasthenia gravis has improved drastically
in recent years, with the mortality rate for patients with generalized myasthenia
30 percent, 31 percent showing deterioration or remaining unchanged, and
only 29 percent having an improvement in their condition before 1958. Now,
with optimal care, the mortality rate is essentially zero, although most
patients must take immunosuppressive medication indefinitely.
Knowing what we do about the disease itself, it seems logical that medical
management of myasthenia encompasses two general facets. These two facets
include transmission boosting and immunosuppression. Management of myasthenia
gravis varies according to the severity of the disease, the age of the patient,
and the type of myasthenia the patient has.
About 10 percent of the diseaseís victims die. For those who survive
the first three years, there is a chance for stabilization ad even some
degree of recovery.
The main therapeutic modalities for treatment of myasthenia gravis include
the use of cholinergic or anticholinesterase drugs that interfere with the
activity of the enzyme acetylcholinesterase, immunosuppression therapy,
removal of the thymus, and plasmapheresis.
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