Myasthenia gravis causes muscle weakness due to the immune system attacking neurotransmitter receptors on muscle tissue. Since the muscle can’t receive the signal to contract, people with myasthenia become weak. While this neuromuscular junction disorder used to always be disabling and even fatal, now it can usually be managed with various therapies.
There are five general ways of treating myasthenia gravis.
Some methods are best used in acute crises in order to keep someone out of an intensive care unit, although this is still sometimes necessary in extreme cases. Others are meant more to avoid such crises happening in the first place — a preventive strategy.
Avoid Triggers to Prevent Myasthenic Attacks
Because it’s an autoimmune disease, anything that ramps up the immune system can potentially increase the risk of a myasthenic crisis, with severe worsening that could send someone to the intensive care unit. Noticing and avoiding any triggers is a key factor in managing the disease. For example, commonly-used medications like ciprofloxacin or other antibiotics, and beta-blockers like propranolol, lithium, magnesium, verapamil and more, can worsen the symptoms of myasthenia gravis. In general, people with myasthenia should be very cautious before starting any new medication and watch carefully afterward for signs of weakness.
Treating Symptoms of Myasthenia Gravis
The weakness of myasthenia gravis occurs when the acetylcholine receptor is attacked by the body’s immune system. Supplementing the amount of acetylcholine available at the neuromuscular junction can help overcome this deficit. The body usually clears acetylcholine from the synapse by means of enzymes called acetylcholinesterases.
Drugs called cholinesterase inhibitors (which block the action of these enzymes) can result in the acetylcholine being left in the synapse for a longer period of time, allowing it to bind to receptors that signal muscles to contract.
Acetylcholinesterase inhibitors include pyridostigmine (Mestinon), which is the main drug in use for myasthenia gravis. Side effects include diarrhea, cramping, and nausea. Taking the medication with food can help reduce these side effects. Strangely, sometimes excessive anticholinesterase medication has a paradoxical side effect of weakness, which can be difficult to distinguish from the myasthenia itself. This is very rare if pyridostigmine is used within recommended doses, though.
Chronic Immunotherapy for Myasthenia Gravis
Most people with myasthenia gravis end up taking medication to prevent symptoms from coming on at all. Immunotherapy targets the underlying antibodies that attack the acetylcholine receptors. By changing the immune system, the frequency and severity of attacks are reduced.
Glucocorticoids such as prednisone are often used to suppress the immune system of people with myasthenia. Other options include cyclosporine, azathioprine, and mycophenolate. All of these medications have potential side effects, some of which are quite serious. The risks of the medication must be carefully weighed against the benefits of fewer and less severe attacks of myasthenia.