Treatment Options for Myasthenia Gravis, Plus Support and Tips

There’s no cure for gMG. But the vast majority of people improve with treatment, often going into remission.

The goal of treatment is to manage symptoms such as:

• muscle weakness
• breathing problems
• difficulty swallowing

Treatment can involve medication, surgery, or a combination of therapies. A healthcare professional can help you decide on treatment for gMG based on a variety of factors, such as:

• your age and overall health
• which muscles are affected
• the severity of your symptoms
• whether you’re pregnant or nursing
• how well you tolerate specific medications
• personal preferences

Here are some of the treatment options for gMG:

Cholinesterase inhibitors

This type of oral medication, which includes pyridostigmine (Mestinon), improves signaling between nerve cells and muscles.

Cholinesterase inhibitors are fast acting. They can help ease muscle contractions and improve muscle strength.

Side effects can include:

• upset stomach
• sweating
• muscle twitching

Corticosteroids

Corticosteroids, such as prednisone, are a common gMG treatment used since the 1960s, according to a 2019 research review.

These oral medications work by limiting the production of atypical antibodies. They also help reduce inflammation.

Benefits of corticosteroids include their low cost, wide availability, and fast results. However, long-term use of this medication can increase the risk of severe side effects.

Side effects may include:

• osteoporosis
• skin atrophy
• glaucoma
• higher likelihood of infections

Immunosuppressants

Immunosuppressants treat gMG by reducing the activity of your immune system. These medications include:

• azathioprine (Azasan, Imuran)
• cyclophosphamide (Cytoxan, Neosar)
• cyclosporine (Gengraf, Neoral, Sandimmune)
• methotrexate (Rheumatrex, Trexall)
• mycophenolate mofetil (Cellcept)
• tacrolimus (Astagraf XL, Envarsus XR, Prograf)

It can take several months to see results from this treatment. Side effects of immunosuppressants may include increased risk of infection and damage to the liver or kidneys.

Monoclonal antibodies

One of the newer gMG treatments is monoclonal antibodies, such as rituximab (Rituxan) and eculizumab (Soliris). A healthcare professional will deliver these medications through an IV infusion.

Monoclonal antibodies target specific components of the immune system to help suppress overactivity.

Side effects can include:

• headache
• nausea
• low blood pressure

Intravenous immune globulin therapy

Intravenous immune globulin therapy (IVIG) might be an option if your gMG symptoms worsen.

Immune globulin is made from donor blood products with standard antibodies. These help destroy atypical antibodies that cause gMG and block the production of new ones.

IVIG is typically used as a treatment for severe or rapidly worsening gMG. It can also provide temporary relief while you’re waiting for immunosuppressants to kick in.

Most people tolerate IVIG well, according to 2018 research. Yet, common side effects include:

• headache
• flushing
• fever
• chills
• fatigue

Plasma exchange

In this procedure, also known as plasmapheresis, a healthcare professional uses a machine to remove plasma with atypical antibodies that cause gMG and replace it with either healthy plasma from a donor or a plasma substitute.

Because your body will continue to produce the atypical antibodies, this is a temporary fix. It’s usually used in severe cases or in preparation for surgery.

Side effects can include:

• fever
• rash
• low blood pressure

Surgery

In some cases, your doctor might recommend surgical removal of your thymus gland. This procedure is known as a thymectomy.

The thymus, which is part of the immune system, is located behind your breastbone.

Some people with gMG develop a tumor in the thymus gland (thymoma). Though the tumors are usually benign, they can become malignant (cancerous).

With or without a tumor, removal of the thymus can lead to remission from gMG and reduce the need for other medications.

Around 25 percent of people with myasthenia gravis experience a serious complication of gMG, called a myasthenic crisis, at some point during the course of their disease.

A myasthenic crisis involves extreme muscle weakness, especially involving the muscles in the diaphragm, chest, and throat. This can lead to shallow breathing or a blocked airway.

It’s a potentially life threatening complication that requires immediate medical intervention. This may include:

• supplemental oxygen through a face mask
• a ventilator to help with breathing until muscle strength improves
• IVIG therapy
• plasma exchange

This can happen when you:

• are under a lot of stress
• have a respiratory infection
• experience a side effect from a medication

But in about half of all cases, there’s no known cause, according to the National Institute of Neurological Disorders and Stroke.

Research and clinical trials for gMG treatment are ongoing. They could help researchers learn more about the condition and ways to treat it.

Clinical trials are studies that measure the safety and effectiveness of new treatments that are not yet approved for general use. You may consider talking with your doctor about whether there’s a clinical trial you could join, along with the risks and benefits of participating.

You can also search for “myasthenia gravis” on clinicaltrials.gov. This will pull up a list of trials, including those that are actively recruiting participants.

Finding the right treatment is important to reducing symptoms of gMG. But you can also do other things to help manage the condition.

These include:

• Carve out enough time for a full night’s sleep.
• Rest your eyes throughout the day.
• Nap as needed.
• Exercise regularly.
• Monitor your energy levels and adjust activity as necessary.
• Tackle the most strenuous tasks earlier in the day.
• Eat a nutritious, balanced diet.
• Try stress management techniques, such as deep breathing, massage, and meditation.
• Avoid extreme temperatures and humidity when possible.

Treatment helps most people with gMG lead full, active lives. But living with a chronic condition can be challenging.

Sometimes, it helps to connect with others who just “get it” because they’re going through the same thing. Social networking and support groups specifically for people with gMG include:

• RareConnect
• DailyStrength
• NeuroTalk

You can continue to learn more about gMG and coping with chronic conditions through these organizations:

• Myasthenia Gravis Foundation of America
• Myaware
• American Autoimmune Related Diseases Association

You can also ask your doctor where to get good information and for referrals to local resources.

Advances in treatment for gMG over the last couple decades have helped people with the condition experience fewer symptoms and maintain healthy, active lifestyles. Treatment options can include medications, surgery, and other therapies.

Your doctor can help you find the right treatment based on your overall health, age, and severity of symptoms.

It’s important to discuss the potential benefits and side effects of each type of treatment, as well as other steps you can take to help manage symptoms of gMG.