Treatment Options for Myasthenia Gravis

Myasthenia gravis is a medical condition that causes muscle weakness in the eyes, face, throat, neck, and limbs. For myasthenia gravis patients, it can be difficult to breathe, swallow, see, walk, and control various muscle groups. But, with medical assistance, these patients can receive a proper diagnosis and explore a wide range of myasthenia gravis treatment options.

Myasthenia Gravis Prognosis

A doctor may use a myasthenia gravis blood test, neurological examination, and physical assessment to evaluate a patient. He or she may also request any of the following tests to determine if a patient is coping with myasthenia gravis:

• Ice Pack Test: This assessment can be used if a patient is dealing with a droopy eyelid. During the test, a doctor places an ice pack on a patient’s droopy eyelid for approximately 2 minutes. The doctor then removes the ice pack and looks for any signs of improvement. 

• Repetitive Nerve Stimulation (RNS): With RNS, a doctor attaches electrodes to a patient’s skin. Next, the doctor sends small pulses of electricity via the electrodes to measure a nerve’s ability to emit a signal to a muscle.

• Single-Fiber Electromyography (EMG): An EMG lets a doctor assess the electrical activity between a patient’s brain and muscle. 

Multiple tests can be used to assess the skeletal muscles and muscle strength. The tests allow a doctor to determine if myasthenia gravis is the root cause of various symptoms. They can help a doctor evaluate the severity of symptoms in people with myasthenia gravis as well. 

If a doctor believes their patient is coping with myasthenia gravis, a personalized treatment plan is developed. In instances where a patient is dealing with myasthenia gravis that affects the skeletal muscles and muscle strength, he or she may be diagnosed with a generalized form of the disorder. Comparatively, if a patient is coping with muscle contraction issues that hamper their ability to open and close the eyes, this individual may be diagnosed with ocular myasthenia gravis.   

Myasthenia Gravis Treatment

Common generalized myasthenia gravis treatment options include:

1. Myasthenia Gravis Medications

Myasthenia gravis medications may help patients manage their symptoms. Medications used to treat myasthenia gravis include: 

• Cholinesterase Inhibitors: Improve communication between nerves and muscles. Cholinesterase Inhibitors have been shown to enhance muscle contraction and strength; however, they may also cause diarrhea, nausea, and other side effects.
• Corticosteroids: Limit the production of antibodies that may contribute to myasthenia gravis symptoms. Corticosteroids may help myasthenia gravis patients temporarily relieve their symptoms, but prolonged use of these medications may cause weight gain, diabetes, and other long-term health issues.
• Immunosuppressants: Support the immune system. Myasthenia gravis patients may need to take immunosuppressants for several months before they notice the effects of these medications. Also, there are serious side effects associated with immunosuppressants, including liver or kidney damage and infection.

Medications may be used as a starting point for myasthenia gravis treatment. If medications are ineffective or cause side effects, additional treatment options may be required.  

2. Intravenous (IV) Therapy

IV therapy may be used to provide short-term relief of myasthenia gravis symptoms. Some of the IV therapies available to myasthenia gravis patients include: 

• Plasmapheresis: Removal of antibodies that block signals from the nerve endings to associated muscle receptor sites.
• Intravenous Immunoglobulin (IVIg): Addition of normal antibodies to the body.
• Monoclonal Antibody: The use of intravenous antibody medications for patients who did not respond to prior treatments.

3. Myasthenia Gravis Thymectomy 

Myasthenia gravis thymectomy may be used to remove a tumor (thymoma) from the thymus gland. It can be performed as open or minimally invasive surgery. Additionally, video- and robot-assisted thymectomy may be completed. 

Video-assisted thymectomy involves the use of a long, thin camera (endoscope) and small instruments to remove a thymoma. Robot-assisted thymectomy involves the removal of a thymoma with assistance from a robotic system that includes a camera and mechanical arms.

How Is Ocular Myasthenia Gravis Treated?

Research indicates immune suppression with steroids can be effective to help patients diagnosed with ocular myasthenia gravis. For these patients, steroid doses must be increased gradually. Otherwise, they face a high risk of a myasthenic crisis.

Which Myasthenia Gravis Treatment Will Restore Muscle Strength?

People with myasthenia gravis can undergo any of the aforementioned treatment options to restore muscle strength. However, the effectiveness of treatment varies based on the patient. 

In order to restore muscle strength and regain the ability to properly contract the skeletal muscles, it is essential to pursue treatment for myasthenia gravis at the onset of symptoms. This ensures a patient can receive a medical diagnosis and treatment and work toward addressing their symptoms before they escalate. 

Which Is the Best Treatment for Myasthenia Gravis?

To treat myasthenia gravis, it is important to consult with an expert facial plastic and reconstructive surgeon. In doing so, a patient can receive a full evaluation and custom treatment recommendation. 

Dr. Babak Azizzadeh of The Facial Paralysis Institute is globally recognized for his facial plastic and reconstructive surgery and head and neck surgery expertise. He is available to assist patients who have been diagnosed with myasthenia gravis or are considering treatment options. To learn more or to schedule a consultation with Dr. Azizzadeh, please contact us online or call us today at (310) 657-2203.