Myasthenia Gravis

Treatment

Mayo Clinic offers all currently available treatments for myasthenia gravis. Each member of the treatment team has special training or knowledge about the disease. They work together to find the best treatment or combination of treatments for each patient. Mayo specialists treat hundreds of myasthenia gravis patients. This extensive experience is invaluable in prescribing the correct treatment for each patient.

At Mayo Clinic, a neurologist with special expertise in myasthenia gravis coordinates the multidisciplinary team. This specialist collaborates with expert colleagues in the EMG and neuromuscular laboratories to diagnose the condition. If treatment is necessary, the coordinating neurologist provides counseling, education and follow-up care either directly or in partnership with the referring physician. If surgical treatment is an option, a thoracic surgeon with special expertise in treating myasthenia gravis is included in the team of specialists.

Several treatments are available for myasthenia gravis, depending on how the disease affects the patient.

Medications

Anticholinesterase drugs help improve nerve-muscle communications and increase 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 may also be used to improve muscle strength. They suppress the immune system's production of abnormal antibodies.

Removal of the thymus gland is effective in more than 70 percent of people with myasthenia gravis. Mayo offers a minimally invasive procedure.

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Surgery

Researchers believe the thymus gland affects myasthenia gravis. Removal of the gland (a thymectomy) brings relief to more than 70 percent of those who have the disorder. Because the body's immune system needs to adjust, response to removal of the thymus is not immediate. Months or years can pass before symptoms are controlled fully. Under the neurologist's direction, patients can gradually taper off medications.

The thymus gland is in the upper center of the chest, just below the sternum. At Mayo Clinic, when thymectomy is recommended, a thoracic surgeon with expertise in treating myasthenia gravis patients performs the procedure. Mayo Clinic in Rochester is one of the few centers in North America to offer minimally invasive thymectomy for patients with myasthenia gravis. The results are similar to traditional thymectomy, but usually the patient's pain and recovery time are reduced significantly.

Sometimes, a tumor (thymoma) is discovered in the thymus gland of patients with myasthenia gravis. When a thymoma is diagnosed, the neurologist consults colleagues in thoracic surgery and oncology. Minimally invasive thymectomy is an option if the tumor is relatively small (less than 2 centimeters in diameter). For a larger tumor, the surgeon and oncologist (cancer specialist) develop the best treatment plan for the patient. Usually, the thymus gland and thymoma are removed surgically through an incision in the sternum. In some cases, radiation therapy or chemotherapy may also be required.

Plasmapheresis and Intravenous Immune Globulin therapy

Typically, these treatments are performed for patients who have severe cases of myasthenia gravis, including arm or leg weakness, or difficulty talking, eating or breathing. At Mayo Clinic, the neurologist coordinates these treatments with experts in intensive care, anesthesiology and the blood bank. Plasmapheresis exchanges the patient's blood plasma (containing harmful antibodies) for plasma from a healthy person or replacement fluid. In immune globulin therapy, immune globulin (antibodies which are extracted from healthy individuals to help fight disease) is infused into patients to disrupt the abnormal immunological response present in myasthenia gravis.