Re: Myasthenia Gravis and surgery

Posted By CCF Neuro MD MJD on October 09, 1998 at 16:40:27:

In Reply to: Myasthenia Gravis and surgery posted by Jennie on October 09, 1998 at 16:13:10:






Hi!
I was diagnosed with MG over 2 years ago, and I have had a thymectomy and been on prednisone.  I have also had many svere crises, but at the moment I am doing well.  I am only on mestinon 60mgs 3x a day.  I am having hand surgery, and it will be done with a general.  The neuro is thinking about doing a course of prednisone before surgery, but previous experiences with prednsione has been horrific.  I was wondering any other treatment exisited out there besides prednsione.
Thank you,
jennie



  _______
In a situation like this, there are a few options.  Surgery can induce crises and, given your history in the past, it may be best to keep cautious.  If you've been doing very well recently and have improved since thymectomy, some might suggest an expectant approach.  See how you do with surgery - but unless you're doing quite well now, it may be best to pretreat you in some way.  It sounds like your off Steroids now and have reacted poorly in the past.  If you have had bad reactions to steroids, you might want to ask your doctor about a course of Plasma Exchange or about infusions with Intravenous Gammaglobulin for a course before surgery. Both have been used in people to pretreat (you may have even gotten one of these before your thymectomy) and can be of help.  Remember though that they have their own group of side effects (and there is a shortage of IV Gammaglobulin right now), so ask your doctor to explain the options and which he'd suggest for you.