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Review
. 2018 May;36(2):311-337.
doi: 10.1016/j.ncl.2018.01.011.

Treatment of Myasthenia Gravis

Constantine Farmakidis  1 , Mamatha Pasnoor  1 , Mazen M Dimachkie  2 , Richard J Barohn  1
Affiliations
Review

Treatment of Myasthenia Gravis

Constantine Farmakidis et al. Neurol Clin. 2018 May.

Abstract

With specialized care, patients with myasthenia gravis can have very good outcomes. The mainstays of treatment are acetylcholinesterase inhibitors, and immunosuppressive and immunomodulatory therapies. There is good evidence thymectomy is beneficial in thymomatous and nonthymomatous disease. Nearly all of the drugs used for MG are considered "off-label." The 2 exceptions are acetylcholinesterase inhibitors and complement inhibition with eculizumab, which was recently approved by the US Food and Drug Administration for myasthenia gravis. This article reviews the evidence base and provides a framework for the treatment of myasthenia gravis, highlighting recent additions to the literature.

Keywords: Complement inhibition; Immunotherapy; Intravenous immunoglobulin; Myasthenia gravis; Plasma exchange; Prednisone; Pyridostigmine; Thymectomy.

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Figures

Fig. 1.
Fig. 1.
Arteriovenous fistula for plasma exchange in myasthenia gravis.
Fig. 2.
Fig. 2.
Wolfe et al thymectomy in MG. (Data from New England Journal of Medicine 2016;375(6):511–522.)
Fig. 3.
Fig. 3.
Suggested algorithms for the treatment of generalized myasthenia gravis and myasthenic crisis. (A) Generalized myasthenia gravis treatment. (B) Myasthenic crisis and severe exacerbation treatment. a If not better, consider eculizumab.
See this image and copyright information in PMC

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