Treatments of Myasthenia gravis

Physiotherapy treatment of Myasthenia Gravis

Build and maintain your muscular strength
Utilise warm up effects to reduce the impact of Myasthenia Gravis
Develop strategies for effective management of your condition specific to your individual needs
Decrease your risk of falling
Enhance your ability to function daily
initial appointment will involve an assessment with to review current mobility, movement that at each of joints, coordination, balance and strength. physio will also assess your capabilities with functional tasks like walking, standing, sitting and lying and how you cope manoeuvring into each position. The outcome of this initial review will then be discussed between you and your physiotherapist and some main goals will be set for you. You will then follow a programme of clinic or home treatment with your physiotherapist along with some home activities to help with your progression. The activities you complete with your physiotherapist may focus on:


Muscle strengthening
Joint flexibility / range
Completion of functional tasks and maintenance of independence
Balance
Smoothness and coordination of activities


Medications
• Cholinesterase inhibitors. Drugs such as pyridostigmine (Mestinon) enhance communication between nerves and muscles. These drugs don't cure the underlying problem, but they do improve muscle contraction and muscle strength. Possible side effects may include gastrointestinal upset, excessive salivation and tearing, and frequent urination.
• Corticosteroids. These types of drugs inhibit the immune system, limiting antibody production. Prolonged use of corticosteroids, however, can lead to serious side effects, such as bone thinning, weight gain, diabetes, increased risk of some infections, and an increase and redistribution of body fat.
• Immunosuppressants. Your doctor may also prescribe other medications that alter your immune system, such as azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) or mycophenolate (CellCept). Side effects of immunosuppressants can be serious and may include increased risk of infection, liver damage, infertility and increased risk of cancer.


Therapy
• Plasmapheresis (plaz-muh-fuh-REE-sis). This procedure uses a filtering process similar to dialysis. Your blood is routed through a machine that removes the antibodies that are blocking transmission of signals from your nerve endings to your muscles' receptor sites. However, the beneficial effects usually last only a few weeks. Repeated treatments can lead to difficulty gaining access to a vein, which may require implanting a catheter, a long, flexible tube, into your chest. Another risk associated with plasmapheresis is a drop in blood pressure. Bleeding occasionally occurs because of the medications used to keep the blood from clotting during the procedure. It's also possible to develop an allergic reaction to the solutions used to replace the plasma or to the sterilizing agents used for the tubing.
• Intravenous immune globulin. This therapy provides your body with normal antibodies, which alters your immune system response. It has a lower risk of side effects than do plasmapheresis and immune-suppressing therapy, but it can take a week or two to start working, and the benefits usually last no more than a month or two. Side effects, which usually are mild, may include chills, dizziness, headaches and fluid retention.


Surgery
About 15 percent of the people who have myasthenia gravis have a tumor in their thymus, a gland under the breastbone that is involved with the immune system. If you have such a tumor, you'll need to have your thymus removed.
For people with myasthenia gravis who don't have a tumor in the thymus, it's unclear whether the potential benefit of removing the thymus outweighs the risks of surgery.
Surgery is not recommended by most doctors if:
• Your symptoms are mild
• Your symptoms involve only your eyes
• You're older than 60