Myasthenia gravis can be a frustrating disease. Symptoms like vision changes, trouble swallowing, and weakness in your limbs may make it hard to do the things you did before your diagnosis life. In some cases, the condition makes it hard for you to breathe and can be life-threatening.
The good news about myasthenia gravis, however, is that there are many treatments out there. There’s no cure, but medications and surgery can help make life more manageable.
But how do you know which treatment is best for you? And how do you know it’s working? Here’s a guide.
What Are My Treatment Options for Myasthenia Gravis?
There are several treatment categories for myasthenia gravis:
Treatment for symptoms. Your doctor may want to use cholinesterase inhibitors to help with muscle weakness. These medications boost signals between your nerves and muscles. This helps to improve muscle strength. The most common one is pyridostigmine.
Immunosuppressants. They curb your immune system’s response so it can’t make antibodies that trigger symptoms. Examples include:
- Corticosteroids such as prednisone
- Azathioprine
- Mycophenolate mofetil
- Tacrolimus
Thymectomy. This is surgery to remove your thymus gland. It’s thought to treat myasthenia gravis since it rebalances your immune system.
The fourth category is infusions. You get them through an IV in your doctor’s office. They include:
Biologics. These are powerful drugs that stop or slow inflammation. They often work by curbing certain substances in your body like specific proteins that lead to disease. Common ones are:
- Eculizumab
- Efgartigimod alfa
- Ravulizumab
- Rozanolixizumab
Intravenous immunoglobulin (IVIG). This is a concentrated injection of antibodies collected from healthy donors. It’s often done at the same time as plasmapheresis. That’s when a machine is used to clean harmful antibodies from your body. They’re then replaced with IVIG.
How Do I Know My Myasthenia Gravis Treatment Is Working?
Once you start treatment, you most likely won’t see results right away. Some drugs, like corticosteroids, start to work within about 2 weeks. Others, such as azathioprine or mycophenolate mofetil, can take up to 6 months or a year to work. In these cases, your doctor may suggest taking a corticosteroid at the same time to get some relief before the other drug kicks in.
To get a sense of how well your current treatment is working, your doctor may have you fill out a self-assessment form called the MG-QOL15. It gives you and your doctor a sense of how much symptoms impact your life. On a scale of 0-2, you’ll let your doctor know certain things, like if you:
- Feel frustrated, depressed, or overwhelmed by your condition
- Have trouble walking, speaking, and generally taking care of yourself
- Find it hard to eat
They’ll also want to know how myasthenia gravis has affected your:
- Social life
- Hobbies and other things you enjoy
- Ability to drive, go grocery shopping, and run errands
Your doctor will also have you fill out another questionnaire called the Myasthenia Gravis Activities of Daily Living (MG-ADL) chart. You rate yourself from 0-3 on eight activities:
- Talking
- Chewing
- Swallowing
- Breathing
- Brushing teeth or combing hair
- Ability to get up from a chair
- Double vision
- Eyelid droop
They may check other things to see how strong your muscles are. They’ll compare your answers to the ones you gave before starting medication.
How Will My Doctor Know Which Treatment Is Right for Me?
If you have mild or moderate myasthenia gravis, your doctor may start you on a cholinesterase inhibitor first. If that doesn’t work or if your symptoms get better but come back, your doctor may want to use a corticosteroid for a short period of time. Since they often have side effects, they may add another medication such as azathioprine.
Your doctor may recommend a thymectomy right away if you have a thymoma. That’s when cancer cells form in your thymus. It happens in about 10% of people with MG. They might also suggest it if you’re under the age of 50 and have a type of myasthenia gravis known as AChR antibody positive. It usually takes a couple of years for the full benefits of a thymectomy to kick in.
Plasmapheresis and IVIG are usually only used in three situations:
- In an emergency (known as a myasthenia crisis)
- To get symptoms under control so you’re strong enough for thymectomy
- To use while you’re waiting for immunosuppressants like azathioprine to kick in
These therapies work very quickly, usually within days. But they only last about 2 weeks.
How Can I Boost My Chances Treatment Will Work?
There are certain drugs you need to avoid when you have myasthenia gravis. They can worsen symptoms. These include:
- Botox
- Quinine for leg camps
- Intravenous magnesium
- Beta-blockers and statins (if they’re needed, they should be the lowest dose possible.)
Use caution with certain antibiotics, too, such as:
Fluoroquinolones. These include ciprofloxacin, levofloxacin, and moxifloxacin.
Macrolides. These include azithromycin, clarithromycin, and erythromycin.
When Should I Go to the Emergency Room?
An illness, stress, or even a medication can trigger myasthenia gravis crisis. But sometimes there’s no known cause.
Call 911 or go to the ER if your symptoms suddenly get worse, especially if you find it very hard to breathe. Your breathing muscles may have weakened so much you need a ventilator’s help. The doctor will also start plasmapheresis and/or IVIG to quickly ease symptoms.
Show Sources
Photo Credit: Tetra Images/Getty Images
SOURCES:
UptoDate: “Overview of the Treatment of Myasthenia Gravis,” “Myasthenic Crisis.”
National Institute of Neurological Disorders and Stroke: “Myasthenia Gravis.”
Myasthenia Gravis Foundation of America: “MG for Professionals,” “Cautionary Drugs.”
