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Myasthenia Gravis

Ocular myasthenia

02/05/2007

Question:

I have had ocular myasthenia sonce 1973. I have taken mestinon and pregnasone but these have not done much to alleviate the double vision and sometime droppy lid. I seem to have a problem with my left eye. A doctor has suggested that I try Celcept. Is this a good choice? I have just turned 65 and I am somewhat concerned about the side effects of this drug. Is there any other suggested treatment for the ociular myasthenis?

Answer:

The treatment of ocular myasthenia without generalized myasthenia can be hard to navigate. You must balance the risk of heavy immunosuppression (prednisone, cellcept, azathioprine) with the symptoms of double vision and a droopy eyelid. Cellcept is usually quite well-tolerated but it may take several months to see benefit on a therapeutic dose. Another thought-- How high have you titrated the mestinon for efficacy? Most of my patients with purely ocular myasthenia do well without immunosuppression and just need mestinon.

Ocular myasthenia usually has waxing/waning symptoms. Think back to what your original symptoms were. Have they changed? Or are they just more of the same? Is there day-to- day and hour-to-hour fluctuation or is just a chronic state without any variation? People with long-standing poorly controlled myasthenia can develop myasthenic myopathy, which is chronic disease of the muscle related to the longtime stress of the muscle. Sometimes other endocrine diseases (thyroid dysfunction, adrenal dysfunction) can mimic myasthenia so make sure you have been evaluated for these. You and your doctor must decide if your symptoms merit immunosuppression and then talk about the risks of the medications and what risks you are willing to accept.

Good luck.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati