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Neurology (Expert Forum)
Re: MG Review
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Re: MG Review
by CCF Neuro MD MJD, Jan 01, 1995 12:00AM
Posted By CCF Neuro MD MJD on September 24, 1998 at 23:38:31:
In Reply to: MG Review posted by Suzanne on September 24, 1998 at 23:27:31:
My husband who is 54 was diagnosed with MG in 1995. He had a thymectomy at that time and a very rocky course following surgery for about 6 months when he required high dose Prednisone (100mg/day for almost a year), plasmaphresis (which was very effective) and has had IGA infusions (series of 3-4) about once a year since that time. He works full time as a high shchool teacher and part-time with church music. He has had a great summer although he has only been able to taper the Prednisone to 15mg one day/ 9 the next at this time. For the last 6 weeks he becomes very weak in the afternoon and evening and has some difficutly in walking and his speech becomes much weaker though not severly. He has recently had an antibody titer which is about 1.4--It was as high as 200 when he was most ill. We don't know why he is having this continued weakness with no apparent cause. Anybody give us any ideas or suggestions? Thanks vey much.
_______
Your doctor should evalute this weakness and how it compares to baseline . Unfortunately, as you know, myasthenia gravis is a chronic disease and, although it can go into remission after thymectomy, it often continues at a lower level. Don't look to the antibodies for an answer - Acetylcholine receptor antibody levels do not correlate with the degree of weakness. It is good that he has been able to taper his prednisone to some degree. Some questions you'll want to be thinking of is whether there have been any changes over the past six weeks - any recent infections, any medication additions? Any changes in his Mestinon? Your doctor will be able to assess this weakness and decide whether it can be treated symptomatically - by changing his Mestinon dose or schedule - or wheter it represents a more severe decline - IVIg or plasmapheresis, especially if they have helped before would be options in these situations. As the symptoms as you describe them do not seem too different, so this probably doesn't represent a situation where his prednisone needs to be increased or another immune drug added. But again after an assessment by his neurologist, whichever options apply can be decided upon
Hope this is of help. Remember, this information is for educational purposes only and does not substitute for a physician's direct evaluation.
In Reply to: MG Review posted by Suzanne on September 24, 1998 at 23:27:31:
My husband who is 54 was diagnosed with MG in 1995. He had a thymectomy at that time and a very rocky course following surgery for about 6 months when he required high dose Prednisone (100mg/day for almost a year), plasmaphresis (which was very effective) and has had IGA infusions (series of 3-4) about once a year since that time. He works full time as a high shchool teacher and part-time with church music. He has had a great summer although he has only been able to taper the Prednisone to 15mg one day/ 9 the next at this time. For the last 6 weeks he becomes very weak in the afternoon and evening and has some difficutly in walking and his speech becomes much weaker though not severly. He has recently had an antibody titer which is about 1.4--It was as high as 200 when he was most ill. We don't know why he is having this continued weakness with no apparent cause. Anybody give us any ideas or suggestions? Thanks vey much.
_______
Your doctor should evalute this weakness and how it compares to baseline . Unfortunately, as you know, myasthenia gravis is a chronic disease and, although it can go into remission after thymectomy, it often continues at a lower level. Don't look to the antibodies for an answer - Acetylcholine receptor antibody levels do not correlate with the degree of weakness. It is good that he has been able to taper his prednisone to some degree. Some questions you'll want to be thinking of is whether there have been any changes over the past six weeks - any recent infections, any medication additions? Any changes in his Mestinon? Your doctor will be able to assess this weakness and decide whether it can be treated symptomatically - by changing his Mestinon dose or schedule - or wheter it represents a more severe decline - IVIg or plasmapheresis, especially if they have helped before would be options in these situations. As the symptoms as you describe them do not seem too different, so this probably doesn't represent a situation where his prednisone needs to be increased or another immune drug added. But again after an assessment by his neurologist, whichever options apply can be decided upon
Hope this is of help. Remember, this information is for educational purposes only and does not substitute for a physician's direct evaluation.
