Therapy of myasthenia gravis, crises in myasthenia

1. Big picture

Myasthenia gravis (MG) is an autoimmune neuromuscular junction disease. Treatment has two separate goals:

1. Improve neuromuscular transmission immediately mainly with acetylcholinesterase inhibitors such as pyridostigmine.

2. Suppress or remove the autoimmune process using corticosteroids, chronic immunosuppression, thymectomy, plasma exchange, or intravenous immunoglobulin.

The most dangerous complication is myasthenic crisis, where weakness affects respiratory and bulbar muscles.

The key exam sentence:

Myasthenic crisis is respiratory failure due to severe MG, requiring urgent airway/ventilation support and rapid immunotherapy with plasma exchange or IVIG.

MG treatment must always be individualized according to:

• ocular vs generalized disease;
• bulbar or respiratory involvement;
• antibody type;
• thymoma or thymic hyperplasia;
• age;
• pregnancy;
• infection;
• medication triggers;
• severity and crisis risk.

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