Myasthenia Gravis

This is an autoimmune condition of the neuromuscular junction, usually presenting with progressive weakness of the muscles associated with the cranial nerves, for example droopy eyelids, double vision or hoarseness. The patient typically wakes up strong, but experiences increasing weakness as the day goes on. The condition is diagnosed by means of EMG (repetitive stimulation), blood test (anti-acetylcholine receptor antibodies) and Tensilon test (weak muscles spontaneously strengthen after injection of Tensilon).

Myasthenia Gravis is highly treatable. Acute symptomatic treatment is with cholinesterase inhibitors, such as Mestinon, however the mainstay of treatment is with immune modulating drugs. Prednisone, Cellcept, methotrexate and azathioprine are all useful. We prefer azathioprine because it is very effective, with a minimal profile of side effects. In addition to azathioprine, we also usually advise monthly treatments with ivIg.

None of our patients has ever been hospitalized for acute exacerbations of their condition (myasthenic crisis). It is our opinion that most people with myasthenia gravis should lead essentially normal lives.

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Michael Hutchinson, MD
345 East 37th Street
Suite 320
New York, NY 10016