Institute of nursing
Treatment Alternatives in the Successful Management of Myasthenia Gravis
I.Clinical question:“Among myasthenia gravis patient, is alternativeImmunomodulatory Therapy effective?”II.Citation:1.Gajdos P, Chevret S, Clair B, et al. Clinical trial of plasma exchange and high-dose intravenous immunoglobulinin myasthenia gravis. Ann Neurol 1997; 41:789-962.Thomas CE, Mayer SA, Gungor Y, et al. Myasthenic crises: clinical features,mortality, complications, and risk factors for prolonged intubation. Neurology1997; 48: 1253-603.Andrews PI, Massey JM, Sanders DB. Acetylcholine receptor antibodies in juvenile myasthenia gravis. Neurology 1993; 43: 977-82III.Study characteristics
Myasthenia gravis is an autoimmune disease that can occur in a limited form involving theoculofacial 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. Inmyasthenic crises, where the respiratory muscles are affected and the condition becomes lifethreatening, immunomodulatory treatment is accompanied by plasmapheresis or intravenousimmunoglobulin to reduce the acetylcholine receptor antibody titre.
Pathogenesis Is Clear
Myasthenia gravis is probably the best understood of the human autoimmune diseasescharacterized by weakness and fatigue ability of the skeletal muscle. It can occur either in alimited form involving the oculofacial muscles or in a more generalized form where the entireskeletal muscle system, including the respiratory muscles, may be affected. Typical symptomsinclude diplopia, ptosis, dysphagia, and proximal muscle weakness, and there is often a disease