Myasthenia gravis (MG) should be classified according to antibody status (acetylcholine, MuSK, LRP4, titin), thymus (hyperplasia, neoplasia, atrophy), age at debut (< or >50 years), symptom localization (generalized, ocular) and severity. With optimal treatment, the prognosis is good in terms of daily functions, quality of life and survival. Symptomatic treatment with acetylcholine esterase is usually combined with immunosuppression. A combination of prednisolone and azathioprine remains the first choice alternative, whereas rituximab is a promising second choice drug for severe generalized MG. Thymectomy is recommended for early-onset, generalized MG and for thymoma MG. In acute exacerbations including MG crisis, intravenous immunoglobulin and plasma exchange have good and similar effects. MG in young females needs therapeutic considerations regarding potential pregnancy.
Da: Future Neurology. 2012;7(6):701-708.