Myasthenia gravis medical therapy: Difference between revisions
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==== Symptomatic treatments ==== | ==== Symptomatic treatments ==== | ||
An oral [[anticholinesterase]] like [[pyridostigmine]] is usually the first drug in [[Myasthenia gravis|MG]] patients.(5) these drugs can reduce the degradation of [[Acetylcholine|Ach]] in the [[synaptic cleft]].(7) [[Limb (anatomy)|limbs]] and [[bulbar]] muscles respond very well to these drugs but [[ocular]] [[symptoms]] including [[diplopia]] are resistance to these medications.(8) | An oral [[anticholinesterase]] like [[pyridostigmine]] is usually the first drug in [[Myasthenia gravis|MG]] patients.(5) these drugs can reduce the degradation of [[Acetylcholine|Ach]] in the [[synaptic cleft]].(7) [[Limb (anatomy)|limbs]] and [[bulbar]] muscles respond very well to these drugs but [[ocular]] [[symptoms]] including [[diplopia]] are resistance to these medications.(8) (manabe az treatment) | ||
==== Chronic immunomodulating treatments ==== | ==== Chronic immunomodulating treatments ==== | ||
* glucocorticoids | * glucocorticoids: There are many studies supporting the beneficial effect of [[glucocorticoids]] like oral prednisone and pulsed intravenous (IV) methylprednisolone in MG patients. This group of drugs can improve the symptoms in almost 50 percent of patients.(6,7,8,11 chronic) the side effects of these drug are: Skin thinning and purpura(13), Cushingoid appearance and weight gain(4), cataracts and glaucoma(7), ischemic heart disease and heart failure(31), gastritis, ulcer formation, and gastrointestinal bleeding(48-49), menstrual irregularities in women and low fertility in both men and women(66-67) and psychiatric and cognitive symptoms(71).(manabe az avareze korton) | ||
* immunosuppressive drugs | * immunosuppressive drugs | ||
# Azathioprine | # Azathioprine | ||
Revision as of 13:26, 21 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
The mainstays of medical therapy for myasthenia gravis are:
Symptomatic treatments
An oral anticholinesterase like pyridostigmine is usually the first drug in MG patients.(5) these drugs can reduce the degradation of Ach in the synaptic cleft.(7) limbs and bulbar muscles respond very well to these drugs but ocular symptoms including diplopia are resistance to these medications.(8) (manabe az treatment)
Chronic immunomodulating treatments
- glucocorticoids: There are many studies supporting the beneficial effect of glucocorticoids like oral prednisone and pulsed intravenous (IV) methylprednisolone in MG patients. This group of drugs can improve the symptoms in almost 50 percent of patients.(6,7,8,11 chronic) the side effects of these drug are: Skin thinning and purpura(13), Cushingoid appearance and weight gain(4), cataracts and glaucoma(7), ischemic heart disease and heart failure(31), gastritis, ulcer formation, and gastrointestinal bleeding(48-49), menstrual irregularities in women and low fertility in both men and women(66-67) and psychiatric and cognitive symptoms(71).(manabe az avareze korton)
- immunosuppressive drugs
- Azathioprine
- Mycophenolate
- Cyclosporine
- Tacrolimus
- Rituximab
- Methotrexate
- Etanercept
- Cyclophosphamide
Rapid immunomodulating treatments
- plasmapheresis
- intravenous immune globulin