How to treat myasthenia gravis 40

CT or MRI is done to examine the thymus, followed by anticholinesterase drugs such as the Tensilon test and the neostigmine test. Electromyography, muscle biopsy.

Thymectomy + hormone + neostigmine + stem cell transplantation + **training**, avoid taking gentamicin, tetracycline, phenagen, diazepam, morphine.

1. Thymus CT, if there is thymoma, thoracic surgery will be removed;

2. Pyridostigmine bromide**;

3. If pyridostigmine bromide is not sensitive and there are still symptoms, add hormones;

4. If the hormone effect is not good, immunosuppressants can be considered;

5. When the symptoms are very severe and the respiratory muscles are involved, plasma exchange can also be considered.

It can be divided into two parts, one is symptomatic, not targeted, and is only used to temporarily improve the symptoms of muscle weakness. The second is to intervene in different links in the pathophysiological mechanism of MG**.

First of all, CT must be done to check whether there is a problem with the thymus, and to fundamentally solve the problem. After that, you can combine Chinese and Western**, and take hormones while taking Chinese medicine**.

Do a CT scan to see if there is any thymoma, and if so, surgery is needed. Oral pyridostigmine bromide is required for symptom control.

Pure Chinese medicine**, tonifying the spleen and kidney, good curative effect, *** small. Tell me about the symptoms.

Inject human immunoglobulin with lyophilization.

Traditional Chinese medicine uses the pulse to distinguish the syndrome and administer the law.

Myasthenia gravis (MG) is an autoimmune disease caused by dysfunction of transmission at the neuromuscular junction, which is clinically manifested as partial or systemic skeletal muscle weakness and fatigue, which worsens after activity and is relieved by rest. The prevalence is 77,150,100,000, with an annual incidence of 4,111,100 million. The prevalence is greater in women than in men, about 3:

2. It occurs in all ages, and children are mostly 1 to 5 years old.

1.Drugs**.

1) Cholinesterase inhibitors are symptomatic drugs, which treat the symptoms but not the root cause, and cannot be used for a long time as a single drug, and the medication method should be gradually increased from small doses. Commonly used are neostigmine methyl sulfate and pyridostigmine bromide.

2) Immunosuppressants Commonly used immunosuppressants are: Adrenocorticosteroid hormones: prednisone, methylprednisolone, etc.; azathioprine; Circumferin A; cyclophosphosamine; Tacrolimus.

3) Plasmapheresis temporarily relieves the symptoms of patients with myasthenia gravis by removing acetylcholine receptor antibodies from the patient's blood, and the effect does not exceed 2 months if it is not assisted by other methods.

4) Intravenous immunoglobulin Human immunoglobulin contains a variety of antibodies, which can neutralize autoantibodies and regulate immune function. Its effect is comparable to that of plasmapheresis.

5) Traditional Chinese Medicine** Traditional Chinese medicine for myasthenia gravis** is receiving more and more attention. Myasthenia gravis falls under the category of "dysentery". According to the theory of traditional Chinese medicine, the addition of traditional Chinese medicine can reduce the risk of immunosuppressants, play an escort role in the treatment of myasthenia gravis, and can rebuild the effect of autoimmune function.

2.Thymectomy surgery.

More than 90% of patients have thymic abnormalities, and thymectomy is one of the most effective means of myasthenia gravis. It is indicated for patients with generalized myasthenia gravis with no contraindications to surgery and presents between the ages of 16 and 60 years, and most patients achieve significant improvement after thymectomy. Patients with thymoma account for 10% to 15% of patients and is an absolute indication for thymectomy.

Myasthenia gravis is a relatively special disease, and its **methods include drugs**, surgery** and special**, mainly according to the condition of myasthenia gravis. If the patient is in the acute stage, the patient is mainly conservative in the drug**, and the drug ** recommends the use of cholinesterase inhibitors, which can achieve good results. In addition to this, there are immunosuppressive drugs, such as hormones, which can also achieve very good ** effects.

For more critically ill patients, gamma globulin can be injected intravenously, and even plasma exchange can achieve good results. Surgery** is mainly for patients with thymic hyperplasia or myasthenia gravis who have thymoma and should undergo thymectomy as soon as possible. Thymectomy surgery, now using minimally invasive means, is done completely through thoracoscopy, with very little trauma, and can also completely remove the hyperplastic adipose tissue in the thymus and its surroundings, so as to improve symptoms and improve myasthenia gravis.

Myasthenia gravis has the following types:

1. Thymectomy has a good effect on patients with thymic hyperplasia or thymoma, and is also considered to be an important means of muscle weakness in Western medicine.

2. Immunosuppressants**, commonly used adrenal corticosteroids, suitable for moderate to severe patients.

3. Drugs**, myasthenia gravis lesions are caused by the reduction of acetylcholine synthesis required for muscle movement in the body, and when muscle weakness is carried out, drugs that increase the function of acetylcholine will be used to improve symptoms.

4. Traditional Chinese medicine**, Chinese medicine believes that myasthenia gravis belongs to the scope of impotence syndrome, which is caused by impaired function of viscera, imbalance of qi and blood, obstruction of phlegm and turbidity, and poor flow of qi and blood. Traditional Chinese medicine** ataxia includes acupuncture, massage and decoction, etc., the most representative is Guyuan Muscle Lifting Soup.

5. Others**, there are immunosuppressants such as radiation**, plasma exchange**, gamma globulin**, which also belong to the ** measures of myasthenia gravis, and patients with myasthenia gravis are generally recommended to go to regular hospitals for standardization**.

1. Western medicine**, which is divided into drugs**, corticosteroids**, and immunosuppressants**.

Drugs include neostigmine, mestigmine, etc., it is worth noting that such drugs need to be taken for a long time or even for life, and each time you need to increase the dosage, and only for the symptoms, once the drug is stopped, the symptoms will be **, and aggravated, and the damage to bones, kidneys and liver should be prevented from such drugs.

Corticosteroids are mainly used for simple ocular myasthenia gravis, cholinesterase inhibitors do not respond well, and patients with generalized myasthenia gravis who are ready to undergo thymecle, and patients with myasthenia gravis who are not suitable for or refuse to undergo thymectomy if their condition worsens, but the dosage is still controversial.

Immunosuppressants are generally used in patients with poor efficacy of cholinesterase inhibitors and corticosteroids, including nausea, vomiting, anorexia, mouth ulcers, hair loss, leukopenia and thrombocytopenia, bleeding and liver damage.

2. Surgery**, surgery ** is the removal of thymus or thymoma, which is only suitable for patients with thymic hyperplasia or thymoma, but surgery will lead to a further reduction in the patient's immunity.

Third, stem cell transplantation, the scope of application is relatively narrow, generally only used for patients with severe myasthenia gravis, and the cost is expensive, the effective rate is very low, and the effect of the maintenance time is relatively short, generally can be maintained for a few years, the Ministry of Health has issued a document prohibiting stem cell transplantation from being used in clinical practice.

Fourth, Chinese medicine **myasthenia gravis, dialectical ** is a major feature of Chinese medicine, according to the theory of traditional Chinese medicine, this disease is mainly closely related to the spleen, kidney and liver, congenital insufficiency, acquired malnutrition, can develop this disease, generally speaking, the earlier ** effect is better.

(a)**.

1.**Scheme.

1) Preferred regimen: thymic gland extraction, if the condition deteriorates significantly after surgery, it can be supplemented with plasma exchange, high-dose immunoglobulin, adrenal corticosteroids and cholinesterase inhibitors**.

2) Secondary regimen: patients with severe disease who cannot remove the thymus can use plasma exchange or high-dose immunoglobulin**, combined with adrenal corticosteroids, and gradually transition to corticosteroids alone, and the thymectomy will be performed after the condition improves and is stable for 2 months, and the original dose is maintained for 2 months after surgery, and then the dose is slowly reduced for 2 to 4 years until it is discontinued.

3) Three options: mg patients who cannot or refuse thymic removal, plasma exchange or high-dose immunoglobulin are preferred for critically ill patients, corticosteroids are preferred for non-critically ill patients**, and other immunosuppressive drugs such as azathioprine can be added in an appropriate amount in the process of corticosteroid reduction to reduce or alleviate the rebound phenomenon.

4) Four options: Immunosuppressive drugs such as cyclophosphamide can be used for mg patients who refuse or cannot undergo thymic removal, and who refuse or cannot tolerate corticosteroids**.