Pyridostigmine is a relatively long-acting drug (when compared to other cholinergic agonists), with a half-life around four hours with relatively few side effects. Generally, it is discontinued in those who are being mechanically ventilated, as it is known to increase the amount of salivary secretions. A few high-quality studies have directly compared cholinesterase inhibitors with other treatments (or placebo); their practical benefit may be such that conducting studies in which they would be withheld from some people would be difficult. Immune suppressants
The steroid prednisone might also be used to achieve a better result, but it can lead to the worsening of symptoms for 14 days and takes 6–8 weeks to achieve its maximal effectiveness. Due to the myriad symptoms that steroid treatments can cause, it is not the preferred method of treatment. Other immune suppressing medications may also be used including rituximab. Plasmapheresis and IVIG
If the myasthenia is serious (myasthenic crisis), plasmapheresis can be used to remove the putative antibodies from the circulation. Also, intravenous immunoglobulins (IVIGs) can be used to bind the circulating antibodies. Both of these treatments have relatively short-lived benefits, typically measured in weeks, and often are associated with high costs, which make them prohibitive; they are generally reserved for when MG requires hospitalization. Surgery
As thymomas are seen in 10% of all people with the MG, they are often given a chest X-ray and CT scan to evaluate their need for surgical removal of their thymus glands and any cancerous tissue that may be present.
After the addition of pathogenic antibodies against the acetylcholine receptor and activation of the complement system, the neuromuscular co-culture shows symptoms such as weaker muscle contractions. References
Further reading
Zhang Z, Guo J, Su G, Li J, Wu H, Xie X (17 November 2014). "Evaluation of the quality of guidelines for myasthenia gravis with the AGREE II instrument". PLOS ONE. 9 (11): e111796. Bibcode:2014PLoSO...9k1796Z. doi:10.1371/journal.pone.0111796. PMC 4234220. PMID 25402504. "NCBI – Diagnostic". www.ncbi.nlm.nih.gov. Retrieved 11 July 2015.