MANAGEMENT OF MYASTHENIA

Doctors usually resort to a variety of treatments, alone or in combination to manage individuals with myasthenia. This may include

  • MEDICATIONS
  1. Cholinesterase Inhibitors: These are the most commonly used mode of treatment and usually the first line of treatment. Drugs like Neostigmine and Pyridostigmine (Mestinon) inhibits the Cholinesterase enzyme that destroys Acetylcholine thereby prolonging the action of Acetylcholine on the nerve endings.
  2. Corticosteroids: Mostly used in patients with positive Acetylcholine receptor antibodies. Drugs like Prednisone ( Wyslone ) inhibits the immune system and limits these Antibody productions
  3. Immunosuppressants: As the name suggests, it suppresses the immune system. The drugs include Azathioprine (Imuran), Methotrexate (Trexall), Mycophenolate mofetil (Cellcept)
  4. Drugs for managing Congenital Myasthenic Syndrome: Anticholinesterase medications, 3, 4 DAP, Quinidine, Fluoxetine, Ephedrine, Terbutaline, Salbutamol are the mainstays of therapy in CMS. Specific diagnosis of a CMS is important as some medications that benefit one type of CMS can be detrimental in another type.
  • INTRAVENOUS THERAPY
  1. Plasmapheresis: This procedure is almost similar to dialysis. The difference being, dialysis removes toxins and waste materials from blood whereas plasmapheresis removes antibodies causing myasthenia.
  2. Intravenous Immunoglobulin ( IVIg ): immunoglobulin is an antibody normally present in the human body. Immunoglobulins are isolated from donors and is believed to affect the creation and function of antibodies
  3. Monoclonal Antibody: Rituximab ( RITUXAN ) usually given as infusions, which depletes certain white blood cells in the immune system thereby altering the immune system and improving symptoms of myasthenia
  • SURGERY:

Usually done in patients whose cause of myasthenia is diagnosed to be a tumor in the Thymus gland known as Thymoma. In some cases, Thymus gland may be removed even if there is no tumor, if the Thymus gland is enlarged, which can eliminate the symptoms and medications could be stopped. But for how long the benefits of Thymectomy remains is still in question. The surgery is maybe is done either as an open surgery or as a minimally invasive procedure.

CONCLUSION

Being a disease with no cure, the patient and their families should make it a point to have a better understanding of the disease, as worsening of the disease can lead to a number of life-threatening complications including Myasthenic Crisis. Medications prescribed to each patient should be taken accordingly and should never be discontinued. Discontinuing or altering a medicine or its dosage alteration should never be done unless recommended by a neurologist with a sound knowledge of your myasthenic condition maintaining a good and healthy lifestyle, moderate exercises to keep your muscles functioning and strengthened, keeping your body weight under control, and a good nutritious diet along with a calm and stress free mental state can help a lot in keeping the condition under control.