[Therapy of myasthenia gravis]

The treatment of myasthenia gravis is a difficult entity. We especially discuss the immunosuppressive treatment with regard to the literature. In patients with thymoma all authors agree in thymectomy. In generalized myasthenia, even without thymoma, thymectomy should be performed in "younger" patients. In "elderly" patients thymectomy as treatment of choice is controversial. The basis of immunsuppressive therapy are corticosteroids, additionally azathioprine can be given considering the delay in response and the major side effects. As today, cyclophosphamide and cyclosporine A are too toxic for routine use, except third choice in therapy resistant patients as ultima ratio. The procedure of choice in myasthenic crisis is plasma exchange if the patient tolerates it. Alternatively intravenous immunoglobulin should be given. In pure ocular myasthenia treatment is controversial in the literature. In the last few years there is a tendency to treat this form early like generalized myasthenia, especially in young patients, to prevent generalization.