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Autoimmune Diseases
Volume 2011, Article ID 847393, 6 pages
http://dx.doi.org/10.4061/2011/847393
Review Article

Myasthenia Gravis: A Review of Available Treatment Approaches

1Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
2Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway

Received 14 April 2011; Accepted 11 August 2011

Academic Editor: Renato Mantegazza

Copyright © 2011 Nils Erik Gilhus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Patients with autoimmune myasthenia gravis (MG) should be further classified before initiating therapy, as treatment response varies for ocular versus generalised, early onset versus late onset, and acetylcholine receptor antibody positive versus MuSK antibody positive disease. Most patients need immunosuppression in addition to symptomatic therapy. Prednisolone and azathioprine represent first choice drugs, whereas several second choice options are recommended and should be considered. Thymectomy should be undertaken in MG with thymoma and in generalised, early-onset MG. For MG crises and other acute exacerbations, intravenous immunoglobulin (IvIg) and plasma exchange are equally effective and safe treatments. Children and females in child bearing age need special attention regarding potential side effects of immunosuppressive therapy. MG pathogenesis is known in detail, but the immune therapy is still surprisingly unspecific, without a pin-pointed attack on the defined disease-inducing antigen-antibody reaction being available.