Medicines for Myasthenia gravis

Treatment works on two fronts. To ease symptoms directly, pyridostigmine — an anticholinesterase — helps the chemical messenger work for longer at the muscle and often improves strength, especially in milder or early disease. To calm the underlying autoimmune process so fewer harmful antibodies are made, corticosteroids are used, often together with a steroid-sparing immunosuppressant such as azathioprine, which allows the steroid dose to be kept lower over the long term. Treatment is overseen by a specialist neurology team and adjusted to how you respond. An important safety point is that some medicines used for other conditions can worsen myasthenia gravis, so always check any new medicine — prescribed or bought over the counter — against the condition.

A myasthenic crisis is a severe worsening of myasthenia gravis in which the muscles used for breathing or swallowing become so weak that they can no longer work safely. It is a life-threatening emergency. Warning signs include sudden or increasing breathlessness, very weak or shallow breathing, choking, difficulty clearing saliva, and serious trouble swallowing or speaking. A crisis can be triggered by an infection, by certain medicines, by stress or by under-treatment, and it can develop quickly. If this happens, call 999 or go to A&E immediately, as it needs urgent hospital treatment, sometimes including support with breathing. Knowing these warning signs and acting fast is one of the most important parts of living safely with myasthenia gravis.

This pattern, called fatigable weakness, is the hallmark of myasthenia gravis. The problem lies at the junction between nerve and muscle, where antibodies interfere with the signal that tells the muscle to contract. When a muscle is used repeatedly, the faulty signalling means it tires far more quickly than normal, so the weakness builds up with activity and through the day. Resting allows the signalling to partly recover, which is why strength is often better in the morning and after a break. This is why pacing activities, building in rest, and tackling important tasks earlier in the day can help. The same mechanism explains symptoms like eyelids that droop more as you tire or a voice that weakens with prolonged talking.

The thymus is a gland in the chest that plays a part in the immune system, and it is often abnormal in people with myasthenia gravis — some have an enlarged or overactive thymus, and a smaller number have a growth of the gland called a thymoma. Because of this link, imaging of the chest is usually arranged to check the thymus when myasthenia gravis is diagnosed. In selected people, removing the thymus with an operation called a thymectomy can improve the condition or reduce the medicines needed, so it is considered as part of treatment for some, particularly where a thymoma is found. Whether thymus surgery is right depends on individual factors and is decided with the specialist team.