Myasthenia Gravis

What should I know about treatments for Myasthenia Gravis?

Will I feel weak after I start taking medications?

Why would a patient not respond to treatment?

What treatments are used when Myasthenia Gravis is severe?

How can I find out about clinical trials on medications?

What kind of decisions does a doctor go through when choosing which drugs to use?

Will I feel weak after I start taking medications?

Patients may continue to feel weak despite medications. The goal of treatment is to improve strength, but this may take time. Medications like Cellcept, cyclosporine or Imuran may take months to work. Mestinon often does not return strength to normal. You may need to discuss whether there has been adequate time for treatments to improve your strength or whether other medications need to be used with your neurologist.

Why would a patient not respond to treatment?

There are several reasons this could occur.

Some patients may develop weakness from a medication that is being used for another condition (like an antibiotic for an infection). See the list of medications to be used with caution for MG at the Myasthenia Gravis Foundation of America website.
You may not be taking the correct dose. For example, Imuran dose is based on your whole body weight and larger people need larger doses.
Other medical problems must be treated. For example, if one develops depression, low thyroid or heart problems, these may produce fatigue, which should not be attributed to MG.
Keep expectations reasonable. Are you trying to do too much? Are you expecting your body to behave like it did at an earlier age?
Rare patients are misdiagnosed and do not have MG. Discuss with your doctor how sure the diagnosis of MG is.

What treatments are used when Myasthenia Gravis is severe?

The best treatments for severe symptoms are plasmapheresis, steroids in high doses, and IVIG. The initial response can be slow (taking months). Most patients with MG do eventually respond. Also, other medications like Cellcept, azathioprine (Imuran), and cyclosporine often need to be started. These take months to work but eventually allow patients to be treated with lower doses of prednisone.

How can I find out about clinical trials on medications?

This information can be found through the National Institutes of Health at http://clinicaltrials.gov.

What kind of decisions does a doctor go through when choosing which drugs to use?

Every time a physician uses a drug, benefits and risks have to be weighed. I look at each case individually and each choice of medication in this way.

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Last Reviewed: Dec 29, 2003

Henry J Kaminski, MD
Professor
Neurological Institute
University Hospitals
School of Medicine
Case Western Reserve University