The Management of Myasthenia Gravis

INTRODUCTION This is a pragmatic guide to the management of myasthenia gravis. We will assume the diagnosis is correct (Hilton-Jones 2002) and the reader understands the pathogenesis of the disorder (Newsom-Davis & Beeson 2001), and we will deal only with pharmacological and surgical management. The mode of action of different pharmacological treatments will not be discussed, but their adverse effects will be. At the time of diagnosis, time must be set aside to adequately explain to the patient the nature of the disease and its management. The treatment strategy, the likely time-course of response, the long-term prognosis, potential complications of therapy, and the undoubted uncertainties about some areas of ‘best practice’ must all be discussed – this is clearly more difficult if the clinician sees relatively few cases of myasthenia, but is nonetheless crucial in optimizing patient adherence to therapy, and so outcome. Many countries have a patient support group–e.g.