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What is the treatment for Myasthenia gravis?

Q: My daughter is 3 years old. She has been diagnosed with Myasthenia gravis. She is taking Mestinon 60 mg, four times daily, as prescribed by her doctor. She is very active and has no problem with eating. But her right eyelid droops badly, though she is taking medication. What is the treatment for this?

A:Your child, I should assume, has been diagnosed with Ocular Myasthenia gravis, based on clinical findings, electrophysiology, chest x-ray and anti-AChR antibodies. Tests for thyroid disease, ANF, etc. must have been carried out. It is obvious that your child is not responding to Mestinon. The dose of 4 tablets of 60 mg each, is on the higher side. I would suggest that you consult your neurologist and try a change to Neostigmine (15 mg tablet) and start with half a tablet four times a day. After a week, the dose could be increased to half a tablet five times a day (Max 2-3 mg/kg/day). It would be sensible to start her on steroids (Prednisolone 15 mg after breakfast) along with antacids and calcium. Steroids may take some time to show benefit. Once her condition improves, your neurologist will gradually taper off the steroids. You should carry a list of drugs that can worsen Myasthenia gravis. This list can be shown to your doctor whenever any medicines for common illnesses are prescribed.

  • Antibiotics (e.g., aminoglycosides, ciprofloxacin, erythromycin, ampicillin)
  • Beta-adrenergic receptor blocking agents (e.g., propranolol, oxprenolol)
  • Lithium
  • Magnesium
  • Procainamide
  • Verapamil
  • Quinidine
  • Chloroquine
  • Prednisolone
  • Timolol (i.e., a topical beta-blocking agent used for glaucoma)
  • Anticholinergics (e.g., trihexyphenidyl)

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