Treatment of Myasthenia Gravis
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Myasthenia gravis (MG) is an antibody-mediated, neuromuscular transmission disorder, which ranges in clinical manifestations of ocular myasthenia that may be visually disabling to myasthenic crisis with patients suffering life-threatening respiratory insufficiency. MG also has pathophysiologic subgroups based on presence or absence of acetylcholine receptor or muscle-specific kinase antibodies and presence of thymoma. Cholinesterase inhibitors partially improve weakness, but the vast majority of patients require therapies that moderate the autoimmune attack. Mortality of MG has been reduced over the last century, but adverse effects of treatment compromise patient care and rigorous evidence to guide the clinician are lacking.
KeywordsMyasthenia gravis Ocular myasthenia Acetylcholine receptor Corticosteroid Azathioprine Mycophenolate mofetil Cyclosporine Intravenous immunoglobulin Plasma exchange Complement Acetylcholine receptor antibody Thymectomy Muscle specific kinase
H.J. Kaminski receives support from grants from the National Institutes of Health R01 EY14837 and R01 NS42685.
Conflicts of interest: V. Kumar: none; H.J. Kaminski has performed consultations for GlaxoSmithKline, Bayhill Therapeutics, Cytokinetics, and Varleigh Limited.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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