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Myasthenia Gravis

Possible start of remission

02/14/2008

Question:

Our 21 year old daughter was diagnosed with mild, generalized MG on June 2007.. after a cat scan and mri an enlarged and hyperplasic thymus was found. On Oct. 2007 she had a robotic thymectomy. She had been on only Mestinon anywhere from 3 to 6 (60mg) pills per day. As of this February... she has gone from days to over a week without needing the mestinon. Isn`t it too soon for remission... we were told the benefits of the surgery might take up to 2 years to kick in?

Answer:

Remission, a reversal of some or all symptoms, occurs in about 20 percent of people with myasthenia. Patients with myasthenia gravis may experience spontaneous remission that can last weeks, months, or years. The remissions are usually temporary, with an average duration of five years. Some people have experienced apparently permanent remissions, lasting over 20 years. Patients in remission might even not require medication.

The thymectomy may or may not be playing a role in her apparent remission. The natural history of myasthenia gravis is like other autoimmune disorders, with periods of exacerbation followed by periods of relative quiescence. While we like to think, as doctors, that we have "tamed" the disease with our drugs and our surgeries, sometimes I think it is just the disease itself having a quiet period. The thymectomy can be very effective, and in the long term, was a great treatment for your daughter because of her age. But this quiet period now may not have anything to do with the thymectomy. I say this so that she still keeps her guard up, and is vigilant about her symptoms, especially any that involve her breathing, swallowing, or talking. But I hope she never needs to take the mestinon again and truly enters remission. Good luck.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati