Approach to treating myasthenia gravis
Do not start treating myasthenia gravis until the diagnosis is confirmed, except in a medical emergency. Management depends on the degree of disability and the muscles involved. Always assess breathing and swallowing. When the patient has isolated ocular symptoms, or only mild to moderate limb or bulbar weakness, they can be managed as an outpatient. If the patient has significant bulbar symptoms, rapidly progressing muscle weakness, or significant respiratory involvement, inpatient management is recommended. Forced vital capacity can help guide admission to intensive care.
Thymectomy is recommended for patients with a thymoma. A 2016 randomised controlled trial supports thymectomy in nonthymomatous anti–Ach-R positive myasthenia gravis patients (younger than 65 years), even when they only have mild generalised myasthenia1.