Diagnosis and treatment of myasthenia gravis.
OBJECTIVE
To describe the clinical presentation, diagnosis, and treatment of myasthenia gravis (MG) while emphasizing the important role of the pharmacist.


METHODS
English-language articles from MEDLINE pertinent to MG study selection and data extraction: All relevant publications addressing MG management were considered, including prospective comparative trials, epidemiological studies, guideline statements, review articles, and editorials. Particular focus occurred on primary literature published after 1976, but limited amount(s) existed. The American Autoimmune Related Diseases Association, Autoimmune Information Network, Inc., Myasthenia Gravis Foundation of America, Inc. (MGFA), National Institute of Neurological Disorders and Stroke, and National Organization for Rare Disorders.


RESULTS
MG is an autoimmune disorder involving the neuromuscular junction causing characteristic weakness in voluntary muscle groups. To determine appropriate pharmacotherapy, one must characterize the disease based on the degree of function and region of muscles affected. MGFA established a classification system of the disease in order to assess severity. Contemporary treatments include cholinesterase inhibitors, corticosteroids, immodulating/immunosuppressive therapy, intravenous immune globulin, plasmapheresis, and thymectomy. Because of the lack of double-blind, placebo-controlled, randomized clinical trials, treatments are less evidence-based than many other disease states. Clinicians should be aware of the different treatments and recognize the best treatment for the individual.


CONCLUSIONS
The diagnosis and treatment of MG is a therapeutic challenge. Pharmacists play an essential role in the care of these patients by avoiding drugs that exacerbate the disease, promoting optimal pharmacotherapy, monitoring pharmacotherapy, and ensuring compliance with prescribed medications.
Virginia Commonwealth University/Medical College of Virginia, School of Pharmacy, Richmond, Virginia, USA.
Stephanie E
SE
Matney
Danny R
DR
Huff
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009157:Myasthenia Gravis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D010593:Pharmaceutical Services; D010956:Plasmapheresis; D013934:Thymectomy
D000305:Adrenal Cortex Hormones; D002800:Cholinesterase Inhibitors; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents