Myasthenia Gravis

Treatment

At Mayo Clinic, doctors who have training in nervous system conditions (neurologists), chest surgeons (thoracic surgeons), cancer specialists (oncologists), researchers and others work as a team to diagnose your condition and determine the most appropriate treatment plan. Doctors often can perform surgery to remove the thymus gland, if required or recommended, usually during or shortly after your initial evaluation at Mayo Clinic.

Mayo Clinic doctors may recommend several treatments for myasthenia gravis, depending on how the disease affects you. Treatment often can lead to long-term remission of your condition. After treatment, your neurologist provides you with counseling, education and follow-up care.

• Medications. Anticholinesterase drugs help improve nerve-muscle communications and increase your muscle strength. Corticosteroids inhibit the immune system and the production of abnormal antibodies, but long-term use can lead to serious side effects. Immunosuppressive drugs alter your immune system and may help improve your muscle strength.

• Surgery. The thymus gland, which is located in the upper center of your chest, may be related to the autoimmune process causing myasthenia gravis. Researchers study the thymus gland and surgical removal of the thymus gland (thymectomy) in people who have myasthenia gravis. A thymectomy often may reduce or eliminate symptoms of myasthenia gravis, which may allow you, over time, to reduce or stop medications that were needed for symptom control. Some people may have a tumor (thymoma) in the thymus gland, which needs to be removed surgically during a thymectomy, as it can cause symptoms of myasthenia gravis and can also grow or spread to surrounding tissues or organs. Mayo Clinic thoracic surgeons who have training and experience in treating myasthenia gravis perform the thymectomy. At Mayo Clinic in Minnesota and Arizona, you may have the option of a minimally invasive thymectomy, which uses a smaller, less invasive incision.

  Because your body's immune system needs to adjust, your body's response to removal of the thymus gland takes time. Months or years can pass before you notice reduced symptoms or long-term remission of your condition. Under your doctor's direction, you gradually can taper off medications as your symptoms improve.

  In a traditional thymectomy, your surgeon splits the entire sternum (central breast bone) to open your chest and remove the thymus gland. Results are generally very good with approximately a five-day hospital stay, followed by a steady return to usual activities over the next six weeks.

  

  Minimally invasive thymectomy

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  In a minimally invasive thymectomy (transcervical or thoracoscopic thymectomy), thoracic surgeons at Mayo Clinic in Minnesota and Arizona perform a thymectomy using video-assisted thorascopic surgery (VATS). In this procedure, your surgeon makes a small incision in your neck and then inserts a long thin camera (videoscope) and tiny instruments to visualize and remove the entire thymus gland without cutting through your breastbone.

• Plasmapheresis and intravenous immune globulin therapy. If you have a severe case that includes arm or leg weakness, or difficulty talking, eating or breathing, your doctor may recommend plasmapheresis or intravenous immune globulin therapy. Plasmapheresis exchanges your blood plasma, which contains harmful antibodies, for plasma from a healthy person or replacement fluid. In immune globulin therapy, you receive an infusion of antibodies (immune globulin) taken from healthy individuals to disrupt the abnormal immune response occurring in myasthenia gravis.