Treatment alternatives in the successful management of myasthenia gravis

Myasthenia gravis is an autoimmune disease that can occur in a limited form involving the oculofacial muscles or in a more generalised form affecting the entire skeletal muscle system. Acetylcholinesterase inhibitors are the first-line treatment of myasthenia gravis and, in most patients, adjunctive immunomodulatory treatment (e.g. corticosteroids) is also indicated. Corticosteroid-refractory myasthenia gravis can be treated with azathioprine or cyclosporin. In myasthenic crises, where the respiratory muscles are affected and the condition becomes life threatening, immunomodulatory treatment is accompanied by plasmapheresis or intravenous immunoglobulin to reduce the acetylcholine receptor antibody titre.