title: Myasthenia gravis: a review of available treatment approaches.
abstract: Patients with autoimmune myasthenia gravis (MG) should be further classified before initiating therapy, as treatment response varies for ocular versus generalised, early onset versus late onset, and acetylcholine receptor antibody positive versus MuSK antibody positive disease. Most patients need immunosuppression in addition to symptomatic therapy. Prednisolone and azathioprine represent first choice drugs, whereas several second choice options are recommended and should be considered. Thymectomy should be undertaken in MG with thymoma and in generalised, early-onset MG. For MG crises and other acute exacerbations, intravenous immunoglobulin (IvIg) and plasma exchange are equally effective and safe treatments. Children and females in child bearing age need special attention regarding potential side effects of immunosuppressive therapy. MG pathogenesis is known in detail, but the immune therapy is still surprisingly unspecific, without a pin-pointed attack on the defined disease-inducing antigen-antibody reaction being available.
authors: Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway.
authors: Nils Erik
authors: NE
authors: Gilhus
authors: Jone F
authors: JF
authors: Owe
authors: Jana Midelfart
authors: JM
authors: Hoff
authors: Fredrik
authors: F
authors: Romi
authors: Geir Olve
authors: GO
authors: Skeie
authors: Johan A
authors: JA
authors: Aarli