Friday, May 15, 2015

Current Treatments For Myasthenia Gravis

Once considered a fatal disease, the symptoms of Myasthenia Gravis (MG) can largely be controlled in most cases. Today there are treatments; including a variety of  drugs and/or surgery, that can help people who suffer from MG lead nearly normal lives.

Having said that, it is important to understand that there isn't one standard treatment for myasthenia gravis. Though a variety of therapies are available, much more is needed to be learned about MG and how it is diagnosed and treated. One thing is true when it comes to the subject of  'myasthenics', the success of one treatment over another is really dependant on the patient. What will be successful for one person, may not work the same way for another. And what works in one part of the body in a patient, may not work for another part of the body.The doctor will no doubt experiment with different
therapies and doses of medications to bring about relief from the symptoms of myasthenia gravis.

There is no 'magic bullet' that covers all situations. The treatment choices for an individual patient requires judgment, experience and often addition research by the doctor. The patient and their doctor must communicate at the highest level possible and even still they may have to make decisions about treatments when the evidence is not clear. The support of doctors, family and friends is important to successful treatment for MG patients.

Usually a neurologist is used to diagnose, treat and to help with the management of the disease. And it would be even more helpful if the neurologist has extensive knowledge and experience in the management of MG. But with the incidence of MG occurring only in 1 person for at least every 10,000 people, it is unlikely that a particular neurologist will have much experience with this rare condition. For that reason, Any patient with myasthenia gravis will do well to take a proactive position with his or her treatment.

Currently, these are accepted therapies for MG:

1. Anticholinesterase Therapy - an attempt to strengthen neuromuscular transmission with the use of drugs such as pyridostigmine bromide (Mestinon, Mestinon extended-release) and neostigmine (Prostigmin).

2. Immunosuppressive drug Therapies- Prednisone; azathioprine (Imuran); cyclophosphamide (Cytoxan); cyclosporine (Sandimmune); mycophenolate mofetil (CellCept).

3. Plasma Exchange - Plasmapheresis

4. Intravenous Immune Globin

5. Thymus & Thymectomy

6. Other Therapies - atropine; pro-banthine; ephedrine

Ideally, the neurologist will go over the various treatment forms with the patient, and together they can decide the best way to move forward. There are pros and cons to the different therapies, and it is important to understand the impact on the patient. The decision will affect the patient's to cope with the condition and with such things as self image. The following are a few factors to consider:

* the patient's current condition - as an illustration, the therapy for a patient that's in a myasthenic crisis and having breathing difficulties would be very different from somebody with droopy eyelids.

* the patient's reaction to the therapy -  undesirable side effects are caused by certain medications such as nausea, dizziness and stomach pains. Such side effects could not be tolerated over long periods.

* daily activities may be impeded because of plasmapheresis that require hospital visits; a thymectomy would require several weeks recuperation after surgery which could have an impact on income and the ability to work.

* cosmetic implications - some therapies will have other physical impacts beyond dealing with the myasthenia. A thymectomy will leave the body scarred, and some medications may cause bloating, or affect appetite and weight gain.

In most circumstances, the first course of treatment is medication. It is important to understand that there is no cure for MG.The drugs used to combat MG only provide temporary relief from the symptoms to help the muscles of the body function normally. Furthermore, there is a danger of using drugs that the body may become tolerant of over time, and the drug could become less effective. The choice then may be to move to a stronger drug or to a different form of therapy, such as a thymectomy, which offers long term management of the condition in some cases.

In under 20% of myasthenics, MG goes into spontaneous remission which lasts longer than a year. It is not understood why MG fluctuates or why natural remissions occur.

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