CURRENT TREATMENT OF MYASTHENIA-GRAVIS

Myasthenia gravis is the best characterised human autoimmune disease. The pathogenesis has been shown to be directly related to the summated actions of multiple antibodies contributing to the polyclonal respons e against nicotinic acetylcholine receptors. The antigen has been puri fied and sequenced, and epitopes that contribute to the autoimmune res ponse are being identified. However, most treatments are still non-spe cific and associated with many side-effects. Therapeutic decision-maki ng in myasthenia gravis still remains difficult, because there is a la ck of controlled studies and empiricism prevails. Therefore, detailed knowledge about effect, limitations and drawbacks of the available the rapies is necessary for developing an appropriate management plan. Thi s review summarises the available data regarding the five commonly use d therapies: cholinesterase inhibitors, thymectomy, corticosteroids, n onsteroidal immunosuppressive drugs and plasma exchange. Alternative f orms of treatment are discussed, especially high-dose intravenous immu noglobuhn therapy, which seems to have only a transient benefit with r apid onset of improvement, but, in contrast to plasma exchange, withou t relevant side effects.