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| ==Medical Therapy== | | ==Medical Therapy== |
| Treatment is by medication and/or surgery. Medication consists mainly of [[cholinesterase inhibitors]] to directly improve muscle function and [[immunosuppressant drug]]s to reduce the autoimmune process. [[Thymectomy]] is a surgical method to treat MG. For emergency treatment, [[plasmapheresis]] or [[IVIG]] can be used as a temporary measure to remove antibodies from the blood circulation.
| | Symptomatic treatments (anticholinesterase ● agents) |
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| ===Medication===
| | ● Chronic immunomodulating treatments (glucocorticoids and other immunosuppressive drugs) |
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| * [[Cholinesterase inhibitors]]: [[neostigmine]] and [[pyridostigmine]] can improve muscle function by slowing the natural enzyme [[cholinesterase]] that degrades [[acetylcholine]] in the motor end plate; the neurotransmitter is therefore around longer to stimulate its receptor. Usually doctors will start with a low dose, eg 3x20mg pyridostigmine, and increase until the desired result is achieved. If taken 30 minutes before a meal, symptoms will be mild during eating. Side effects, like perspiration and diarrhea can be countered by adding [[atropine]]. Pyridostigmine is a short-lived drug with a half-life of about 4 hours.
| | ● Rapid immunomodulating treatments (plasmapheresis and intravenous immune globulin) |
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| * [[Immunosuppressive drugs]]: [[prednisone]], [[cyclosporine]], [[mycophenolate mofetil]] and [[azathioprine]] may be used. It is common for patients to be treated with a combination of these drugs with a cholinesterase inhibitor. Treatments with some immunosuppressives take weeks to months before effects are noticed.
| | ● Surgical treatment (thymectomy) |
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| * [[Penicillamine]]
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| ===Plasmapheresis and IVIG===
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| If the myasthenia is serious (myasthenic crisis), [[plasmapheresis]] is used to remove the putative antibody from the circulation. Similarly, [[intravenous immunoglobulin]]s (IVIG) are used to bind the circulating antibodies. Both of these treatments have relatively short-lived benefits, typically measured in weeks.
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| ====Contraindicated medications====
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| {{MedCondContrAbs
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| |MedCond = Myasthenia gravis|Dicyclomine|Glycopyrrolate|Hyoscyamine|Gemifloxacin mesylate|Methscopolamine bromide|Quinidine gluconate|Orphenadrine|Norfloxacin}}
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| ==References== | | ==References== |