Myasthenia Gravis Treatment

How is Myasthenia Gravis Diagnosed?

A neurologist diagnoses myasthenia gravis using a clinical examination, antibody tests, such as acetylcholine receptor (AChR) antibodies and muscle-specific kinase (MuSK) antibodies, repetitive nerve stimulation (RNS) and single-fibre electromyography (SFEMG). A CT or MRI scan of the chest may be performed to check for a thymoma or another thymus abnormality.

How is Myasthenia Gravis Treated Based on Severity?

The treatment for myasthenia gravis depends on the intensity of symptoms, involvement of muscles and occurrence of any associated conditions like difficulty in breathing and swallowing.

The table below gives an overview of myasthenia gravis treatment approach based on its severity:

Types of Myasthenia Gravis and Their Treatment

Myasthenia gravis treatment based on its type is given below:

Myasthenia Gravis Topical Treatments

Topical treatments are suitable for the management of myasthenia gravis because the disease is characterised by problems in the nerve-muscle communication.

However, lubricating eye gels may be prescribed for those who cannot close their eyelids completely, causing dryness.

Other Myasthenia Gravis Treatments

Other treatment alternatives for myasthenia gravis include the following:

Oral Medications for Myasthenia Gravis

Common oral drugs used for treating myasthenia gravis include the following:

• Pyridostigmine: Improves communication between nerves and muscles and provides short-term relief from weakness.

• Prednisolone: Reduces autoimmune activity and may be gradually tapered to the lowest effective dose once symptoms are controlled.

• Azathioprine: A steroid-sparing immunosuppressant used for long-term disease control.

• Mycophenolate Mofetil: Suppresses autoimmune activity and may reduce the need for long-term corticosteroid treatment.

• Tacrolimus: May be used in selected patients whose symptoms remain inadequately controlled with other medicines.

• Cyclosporine: May be considered for selected treatment-resistant cases, but requires kidney function and blood pressure monitoring.

Note: The choice of medication is based on the degree of disease severity, antibody levels, patient’s age, thymic disease presence and the response to treatment.

Ayurvedic and Alternative Treatments for Myasthenia Gravis

Supportive therapies and other alternative treatments that can be utilised in myasthenia gravis are:

• Yoga and breathing exercises may assist in improving flexibility and general well-being.

• Meditation and relaxation techniques can be useful in lowering stress and maintaining overall nerve health.

• Physiotherapy and exercise programs can be useful in facilitating muscle function and movement.

• Ayurveda supportive therapies recommended by a licensed AYUSH practitioner may be utilised along with medical therapy.

Note: Such therapies are recommended as supporting methods only and they cannot replace traditional treatment for myasthenia gravis.

Home Care for Managing Myasthenia Gravis

People who have myasthenia gravis should consider taking care of themselves at home by following these steps:

• Take medicines exactly as prescribed.

• Plan demanding activities for times when muscle strength is better.

• Take regular rest periods and avoid excessive exertion.

• Eat smaller, softer meals when chewing is tiring.

• Use lubricating eye drops in case eyelids are unable to shut the eyes completely.

• Use an eye patch for double vision only as advised and alternate eyes when appropriate.

• Avoid excessive heat and dehydration.

• Check new medicines with the treating doctor.

• Ensure routine neurology follow-ups to assess treatment response.

Seek emergency care for worsening breathing, choking, inability to swallow saliva, or rapidly increasing weakness or weight loss.

How Long Does Myasthenia Gravis Treatment Take?

The course of treatment for myasthenia gravis differs in duration due to the disease's severity and response to medicines. As the condition cannot be cured, myasthenia gravis usually requires long-term management. An approximate duration for response to myasthenia gravis treatment is given in the table below:

Myasthenia Gravis Treatment Side Effects

Some of the side effects associated with myasthenia gravis treatment include:

• Nausea, diarrhoea, abdominal cramps or increased salivation from pyridostigmine

• Weight gain, high blood sugar, mood changes or reduced bone strength from corticosteroids

• Increased infection risk from immunosuppressive medicines

• High blood pressure or kidney problems from tacrolimus or cyclosporine

• Liver abnormalities or reduced blood-cell counts from azathioprine

• Headache, fever or infusion reactions from IVIG

• Low blood pressure, bleeding, infection or electrolyte changes during plasma exchange

• Infusion or injection-site reactions from targeted therapies

• Serious meningococcal infection with complement inhibitors (rare)

• Severe allergic reaction (rare)

Lifestyle Changes for Managing Myasthenia Gravis

Lifestyle changes that should be made for managing the treatment of myasthenia gravis include:

• Schedule activities for times when muscle strength is better.

• Take regular rest periods.

• Avoid excessive physical exertion.

• Take medicines on schedule.

• Eat small, soft meals when chewing is difficult.

• Exercise within limits advised by the doctor or physiotherapist.

• Get sufficient sleep regularly.

• Avoid excessive heat.

• Attend regular neurology follow-ups.

• Use an eye patch for double vision only when advised.

Triggers That Can Worsen Myasthenia Gravis Symptoms

There are some factors which can contribute to the worsening of the symptoms of myasthenia gravis. These can include:

• Respiratory or other infections

• Fever

• Emotional or physical stress

• Sleep deprivation

• Excessive physical activity

• Hot weather or overheating

• Surgery or anaesthesia

• Pregnancy or the period after delivery

• Missed medicine doses

• Thyroid disorders

• Magnesium-containing medicines or supplements

• Fluoroquinolone, macrolide or aminoglycoside antibiotics

• Beta-blockers

• Botulinum toxin

• Other medicines known to impair neuromuscular transmission

Myasthenia Gravis Treatment Cost

Myasthenia gravis treatment in India may cost approximately ₹2,000 - ₹10,000 per month for consultations, monitoring and commonly used oral medicines. Hospital treatment with IVIG or plasma exchange may cost ₹50,000 to several lakhs, depending on body weight, number of sessions, hospital and severity. Thymectomy at a hospital can cost substantially more. Diagnostic tests and long-term follow-up can also incur additional expenses.

Does Health Insurance Cover Myasthenia Gravis Treatment in India?

Health insurance may cover medically necessary hospitalisation, thymectomy, IVIG, plasma exchange and treatment of myasthenic crisis, depending on the policy terms. Routine consultations, long-term oral medicines and rehabilitation may be covered only if the policy includes OPD benefits. Therefore, read the policy terms and conditions carefully before raising a claim.