Myasthenia Gravis (MG)

Although myasthenia gravis cannot be cured, there are several treatment options available for individuals affected by this condition. These can include medications, surgical treatments, and a range of other therapies. The physicians at NewYork-Presbyterian have experience providing the most cutting-edge treatments for myasthenia gravis.

Medications

Anticholinesterase medications (neostigmine and pyridostigmine) can enhance the transmission of nerve impulses and increase muscle strength. Seeing improvements after receiving medication may help the doctor with a diagnosis.

Drugs that suppress the immune system (such as prednisone, mycophenolate, and azathioprine) can suppress myasthenia gravis disease activity. 

Surgical options

The thymus is an immune system organ located in the upper chest beneath the breastbone and is believed to be involved in the development of myasthenia gravis. Many people with myasthenia gravis have tumors on the thymus gland, or the gland is inflamed or has other abnormalities preventing it from functioning properly. The removal of this gland has been shown to benefit many individuals affected by myasthenia gravis.

In the past, the thymus would be surgically removed in a procedure called a thymectomy using an operation that required cutting through the breastbone. This would result in a long inpatient stay in the hospital and considerable discomfort after the surgery. 

NewYork-Presbyterian’s thoracic surgeons are experts in performing a newer procedure for myasthenia gravis treatment, using robotic surgery to remove the thymus. This minimally invasive procedure does not require the opening of the chest, resulting in a far quicker recovery time and less discomfort after the surgery. A small incision is made between the ribs to remove the thymus using a highly precise robotic system controlled by the surgeon. Symptoms improve in as many as 70 percent of patients who undergo this procedure. These improvements may occur months to years after surgery. A thymectomy is most effective early in the course of the disease and for those under the age of 60.

Other therapies

Patients with myasthenia gravis who experience periods of extreme weakness may undergo a procedure called plasmapheresis. This procedure resembles dialysis treatments and involves the filtering of blood through a machine that removes abnormal antibodies causing interference in the transmission of nerve signals to your muscles. However, the benefits of this procedure are usually quite temporary, and repeated procedures can become increasingly difficult as veins are harder to access over time.

Another myasthenia gravis treatment option called high-dose intravenous immune globulin (IVIg) involves patients receiving purified immune system proteins. This treatment can alleviate symptoms of myasthenia gravis by reducing the immune system’s interference with the nervous system.  

Monoclonal antibody treatments may also be recommended, particularly for patients who are not responding well to other treatments. Monoclonal antibodies resemble the antibodies created naturally in the body but are in fact produced in a laboratory. These can target and suppress certain elements of the immune system in order to alleviate symptoms of myasthenia gravis.  

Research

Ongoing research at NewYork-Presbyterian is being conducted to advance the understanding and treatment of myasthenia gravis. Researchers are currently participating in clinical studies to define the most effective role of thymectomy in myasthenia gravis treatment.