Q: I am suffering from Myasthenia Gravis for the last 12 years. My problem is general weakness of the limbs. I don't have any ocular or respiratory problem. I have waddling movement and I need support to move. Wysolone (corticosteroids) wad administered but had no effect. I was told that there is no cure and practically resigned it to fate. Recently while surfing the net I found that thymectomy cures it. I am also taking Distinon (Pyridostigmine), which has greatly alleviated my movements. I would like to know who offers the best thymectomy procedures in India and is well experienced in it. Is laproscopic thymectomy is practiced in India?

A:Myasthenia gravis is a disease affecting neuromuscular transmission and is characterized by weakness and fatigability of skeletal muscles. The disease is caused by a reduction in the number of acetylcholine (Ach) receptors in the muscles. This reduction is due to an acquired autoimmune process in which antibodies to acetylcholine receptors are produced. The disease manifests itself in either an ocular or a generalized form. A large number of drugs are available for treatment even though there is no consensus on which to start first or which to combine. A neurologist should do treatment and a cardio-thoracic surgeon should be consulted if thymectomy is contemplated. An ophthalmologist must be consulted during follow up in case of eye symptoms like diplopia or ptosis. The medicines used include: a) Anticholinesterase Inhibitors – this group of drugs is used as the first line of treatment and they act by increasing the amount of ACh available at the muscles. The improvement is usually partial and frequently decreases after many weeks to months of treatment and needs to be complemented (and sometimes substituted) with immunosuppressive therapy. b) Immunomodulatory Drugs – they are used to suppress the autoimmune process and include prednisone, azathioprine, cyclosporine, IV Ig, and plasmapheresis. c) Thymectomy leads to improvement in more than 80% of patients and nearly 35% patients may not need medicines. There may be some transient worsening of symptoms following surgery and improvement may take months or years. It is important to completely remove all thymic tissue as any residual tissue might lead to recurrence. Some common drugs like aminoglycosides, penicillin, ciprofloxacin, etc. can worsen the symptoms and you should consult the neurologist prior to starting any of these drugs. It is suggested that you consult an experienced neurologist who can advise you appropriately. The doctor will be best placed to refer you for surgery in case it is indicated. Most major hospitals have the facility for this.