Advances in the Treatment of Myasthenia Gravis

Nils Erik Gilhus


Future Neurology. 2012;7(6):701-708. 

In This Article


Optimal treatment of MG depends on correct subclassification of the disease in all individual patients. This includes classification according to autoantibody (AChR, MuSK, titin, other), thymus status, symptom generalization, age of onset and severity. If acetylcholine esterase inhibitor treatment does not give a remission, early thymectomy should be undertaken in early-onset MG, and in those with a thymoma. Immunosuppressive drug treatment should be given to the other patients, and also when thymectomy does not have sufficient effect on MG symptoms. Prednisolone and azathioprine are recommended as first choice drugs, usually in combination. Several second choice options exist. Rituximab has emerged as effective for severe MG. Intense and general treatment is crucial if threatening respiratory failure occurs or is suspected. MG has a good prognosis with no increased death rate, with most patients maintaining all their daily functions including professional working capacity. Follow-up by specialists is necessary to secure optimal treatment regarding effect on muscle strength, as well as to avoid unnecessary side effects. Antibody-specific treatment of the well-characterized autoimmune dysfunction is not yet possible. The cause of MG is unknown apart from in thymoma cases, where the tumor initiates specific autoantibody production. Prevention of the disease, or a cure, remains a challenge for the future, when disease cause(s) have been identified.