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Medication could usually be reduced after operation. disorders, such as Graves diseases, polymyositis,
For some cases, no more MG signs will be seen post- multiple sclerosis, Sjogren’s syndrome, periodic
operation. For children, AChE inhibitors, glucocorticoid paralysis, Hashimoto ‘s disease, rheumatoid arthritis,
and g-globulin are beneficial for generalized form systemic lupus erythematosus, Guillain-Barré
of MG. Otherwise, with cautions, patients could be syndrome, aplastic anemia. In some MG cases, cardiac
treated by immunosuppressants and thymectomy. muscle is also the victim, presenting abnormal EEG
and arrhymia. Therefore, it is recommended to pay
MG crisis: [14,15] it is the compromised respiratory muscle also attention to such condtions other than MG.
leading to severe difficulty in breathing, which has to
be supported by artificial respiration, such as positive Precautions for MG treatment
pressure respiration, endotreacheal intubation and
tracheotomy, and monitoring the oxygen saturation There are certain contraindication for MG patients,
and partial pressure of carbon dioxide. MG crisis could including steroids, antibiotics (e.g. Aminoglycoside),
be classified as in Table 1. For myasthenic crisis, dose antifungal drugs (e.g. amphotericin), cardiovascular
of AChE could be increased within the safe window drugs (e.g. lidocaine, quinidine, β-blockers, verapamil
till there is any improvement. Overdose of AChE could and etc.), antiepileptic drugs (e.g. Phenytoin,
be reversed by atropine or methylprednisolone. For ethosuximide), antipsychotics (e.g. chlorpromazine,
some cases, it is also practical to apply high dose of lithium carbonate, diazepam, clonazepam), anesthesia
g-globulin and plasmapheresis. For cholinergic crisis, (e.g. morphine and meperidine) and anti-rheumatic
treatment with AChE inhibitors should be reduced drugs (e.g. penicillamine and chloroquine).
or terminated and should not resume and increase
gradually until 5-7 days. Atropine or combined with It is also not recommended to do soapsuds enema.
methylprednisolone, plasmapheresis and g-globulin Plenty of rest, staying warm, steady emotion are also
could also be adopted. Nowadays, AChE inhibitors important for recovery from MG.
should be limited at not more than 480 mg per day.
Thus, cholinergic crisis is uncommon. If respiratory Prognosis
failure is found in blood gas analysis (in both type I
and II), endotreacheal intubation and positive pressure Ten-twenty percent of MG patients in ocular form will
respiration should be immediately applied. Artificial spontaneously heal, while 20-30% only experience
respiration of MG patients should have extra care to extraocular MG. For the rest, more than 85% will
prevent lung infection and adjustment of the auxiliary gradually spread the signs to medulla oblongata and
breathing mode for earlier independent breathing. skeletal muscle, developing generalized form in 3 years.
The pathogenesis of MG in about two-third of patients
MG at pregnancy: it is still not very clear that how will develop to severe level within one year. 20% of
[16]
pregnancy affects MG. For most cases, pregnancy will MG patients will develop MG crisis within 1 year.
not aggravate MG and affect the labor time and route. MG signs and symptoms will be aggravated in certain
AChE inhibitors and glucocorticoid are relatively safe conditions such as upper respiratory tract infection,
for fetuses but other immunosuppressants may affect the diarrhea, thyroid disease, pregnancy, fever, trauma and
embryonic development which should be terminated medications affect the neuromuscular junctions.
if pregnant. Teratogenic drugs, e.g. methotrexate and
MMF, should not be used. It is also recommended for Before the prevalent use of immunosuppressants for
MG patients to take caution of contraception. MG treatment, the mortality rate of MG is 30%. With
also the development of mechanical ventilation and
MG with MuSK antibody positive: generally, AChE, intensive care technique, nowadays the mortality
glucocorticoid and immunosuppressants are not (due to directly MG or indirectly other complication)
effective for MG with AChR antibody negative but decreases to below 5%.
MuSK positive. Up to date, there is no special and
effective treatment for this type of MG. plasmapheresis The Chinese version of this guideline has been
could relieve the MG signs for short term. There is published in Chin J Neuroimmunol Neurol
a case report that anti-CD20 monoclonal antibody 2011;18:368-72.
[9]
is therapeutic potent to this type of MG. Multiple
thymectomy is also beneficial for this type of MG. Financial support and sponsorship
Nil.
MG with other complications
Conflicts of interest
Some MG patients could suffer from also other There are no conflicts of interest.

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