BACKGROUND: Myasthenia gravis is a spectrum of disease that there are varied options of treatment. A consensus guideline is conceived by the Neuromuscular Council of the Philippine Neurological Association to summarize all the possible options of treatment in generalized autoimmune myasthenia gravis.
METHODS: Articles were retrieved from 1966 to 2012 from the internet, appraised, summarized, and consolidated to come up with recommendations in this treatment guideline. The American Academy of Neurology classification of evidence (Class I,II,III,IV) and levels of recommendations (Level A, B, C. U) were used.
RESULTS: New insights were found on the pathophysiology of autoimmune myasthenia gravis; reviews and outcome of treatment groups as well as the newest immunosuppressant which is rituximab as added to the armamentarium of medical immunosuppression. There are only a few small population randomized controlled trials on some immunosuppressant drugs like cyclosporine, tacrolimus and mycophenolate. Most studies are retrospective or open labelled studies. Thus, most recommendation grade is at Level C.
CONCLUSION: This guideline summarizes the following: Pyridostigmine is the initial treatment for the mild stage or beginning of myasthenia symptoms. For rapid progressive illness, the option of thymectomy is introduced followed by prednisone followed by azathioprine . For poor responders, the following are additional options: cyclosphosphamide, cyclosporine, mycophenolate, tacrolimus, methotrexate and rituximab. Management of MG crisis is mechanical ventilation, plasma exchangeor IVIg with prednisone and/or azathioprine. IV cyclophosphamide may be given for resistant severe crisis of MG patients.