Disease Management

The management of MG includes the administration of acetlycholinesterase inhibitors, thymectomy, chronic immune suppression, and acute immune modulation (plasma exchange, IV immune globulin), when indicated. Muscle weakness usually does not return to normal with the use of these modalities, and there can be great temporal variability in the nature and amount of muscle weakness. Under- or overdosing can cause significant complications. Variability in the amount of muscle weakness can be seen in response to asthma exacerbations, infections, menstruation, pregnancy, emotional stress, hot weather, and other disorders that alter the response to medication, such as renal and gastrointestinal disease.

Most MG patients show a favorable response to thymectomy. Most show improvement with oral corticosteroids, although some patients initially become weaker prior to symptom improvement when high-dose steroids are administered. Severe MG symptoms often require the use of IV immunoglobulins or a combination of high-dose steroids and plasma exchange.

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