Management of MG: Introduction

Pages to go to from here: Anti-Ach agents, Long-term Immunosuppression, Short-term Immunosuppression, and Thymectomy

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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