Rapid Immunomodulating Treatments for Myasthenia Gravis
Whereas chronic immunotherapy agents are intended to work over a long period of time, some situations require quick action. An example would be a myasthenic crisis, or before a surgery or other necessary event that would be expected to possibly exacerbate such a crisis. Rapid immunotherapies work within days, but their benefits only last for weeks, and they are not usually recommended over a long period of time.
Plasma exchange (plasmapheresis) removes antibodies from the circulation. The process is expensive, and typically occurs about five times over 7 to 14 days. Complications can include arrhythmia, blood cell abnormalities, muscle cramps, and more.
Intravenous immunoglobulin (IVIG) has often been shown to be helpful in diseases caused by an autoimmune reaction, but the exact mechanism is unclear. Treatment usually consists of two to five days of injections. Side effects are usually mild but can include renal failure, meningitis, and allergic reactions.
Surgical Treatment of Myasthenia Gravis
Most people with myasthenia gravis have an abnormality in their thymus, an immune system organ at the base of the neck. Sometimes people’s myasthenic symptoms improve or even resolve after the thymus is removed during a procedure called a thymectomy. There is no guarantee of such an outcome, however. A relatively high percentage of people with myasthenia have a thymus tumor (thymoma), and doctors agree that surgery is indicated in these cases. Whether thymectomy is indicated in other cases is less clear, and should be discussed with a neurologist on a case by case basis.
Myasthenia gravis is a serious disease, but there are many therapeutic options available to both reduce weakness when it occurs and help reduce the frequency and severity of attacks. Because of potential side effects with all medications, the treatment course should be discussed with a neurologist with a good knowledge of myasthenia gravis and its potential complications.