Page 16 - Read Online

400 mg/kg/day for 5 days. Effect of this treatment will Table 1: Differential diagnoses of myasthenic and
onset in 5-10 days and last for 2 months. As similar cholinergic crises
as the plasmapheresis discussed below, side effects Myasthenic crisis Cholinergic crisis
are less but both procedures cannot be combined. For Heart rate Tachycardia Bradycardia
Weak and fasciculation
Weak
Muscle
moderate and severe MG patients, repetitive treatment Pupil Normal or dilated Constricted
of this could not maximize the therapeutic effect. Skin Faint and cold Warm and flushing
Side effects include headache, aceptic meningistis, Secretion Normal Increase
flu signs and renal dysfunction. Neostigmine test MG improved MG aggravated weakness
MG: myasthenia gravis
Plasmapheresis
[13]
this as a popular therapy for MG. This approach
This is mainly for acute cases of MG, myathenic crisis is suitable for those MG patients who experience
and pre-operative treatment for thymectomy. This invasive thymus hyperplasia, reoccurrence of MG
[12]
is also used for cases without further improvement and not sensitive to other medication. Daily treatment
after chronic treatment with immunosuppressants. dose is 1 to 2 Gy and 5 times per week. The total
Plasmapheresis should be performed every other day in amount is 50-60 Gy.
the first week, totally 3 times. If there is no significant
improvement, procedure should be continued once Others
a week for 5-7 weeks. Each treatment introduces Respiratory muscle training and other strength
1,500 mL health human plasma and 500 mL 706
supplement. Significant effect will onset 2 days after training in mild case of MG could improve the muscle
strength. It is highly recommended that patients
the first or second treatment lasting for 1-2 months.
Side effects include hypotension, low blood calcium, should control weight and limit the daytime activity.
infection and hemorrhage. Plasmapheresis should Seasonal flu shot is also beneficial in therapy.
be performed in aseptic environment. Termination Therapies for different types of MG
should be used if there is any complication. MG
patients with infection and receiving perfusion of Ocular MG: although it is more prevalent in children
g-globulin should not receive this procedure. under 10 year old and adult above 40, this could be
seen in any age groups. 80% patients of MG experience
Thymectomy
first with ocular MG which could be controlled by
individualized doses of AChE inhibitors. For better
It is crucial to perform thymectomy for the MG patients
with thymus tumor, which could eliminate risks of treatment, AChE inhibitors could be combined with
invasion and proliferation. Thymectomy could also glucocorticoid and methylprednisolone. In recent
[7]
improve the MG signs of patients. However, in certain review literatures, oral dose of glucocorticoid, e.g.
cases, the MG condition would be worsened. For mild prednisone, is better in treat of ocular MG than only
MG (Osserman class I), thymectomy could not have AChE inhibitors and more effective in preventing the
any improvement. However, for Osserman class II to transformation to generalized forms of MG. However,
IV, particularly those with AChR antibody positive, randomized and blinded clinical trials are needed
thymectomy provides a significant improvement. to confirm this. In order to have better treatment, it
MG signs would be usually reduced 2-24 months is also recommended to apply immunosuppressants
after the operation and medication could be also and glucocorticoid. Thus, glucocorticoid induced side
reduced. Although some MG patients will recover effect could be reduced.
totally after thymectomy, some will experience MG
reoccurrence in a few years. Generally thymectomy Generalized form: as AChE inhibitors are not effective
is beneficial for MG with abnormal thymus glands. enough to control the MG symptoms, treatment
Such operation is suitable for patients older than 18 should combine with glucocorticoid and other
year-old. For severe cases with non-magliant thymus immunosuppressants, e.g. azathioprine, cyclosporine,
tumor, treatments, such as perfusion of g-globulin, tacrolimus and MMF. Some cases of generalized MG
will be firstly recommended than surgery when MG need methylprednisolone, 40-50% of which may be
signs have been slightly improved, which could also worsened during treatment and needed endotracheal
prevent post-operation myathenic crisis. intubation or tracheotomy. High dose of g-globulin
could be used when methylprednisolone fails to
Thymus radiotherapy provide any effect. Thymectomy should be performed
early for those with abnormalities of thymus glands,
The sophistication of radiological techniques makes such as thymus tumor and thymus hyperplasia.

Neuroimmunol Neuroinfammation | Volume 3 | Issue 1 | January 20, 2016 7