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Suggest Treatment For Myasthenia

Posted on Sat, 4 Oct 2014

Question: Sir if you remember i discussed about my father treated for myasthenia at XXXXXXX apolo in name of k.c.rastogi . Thymectomy was done with 5 days prior and 2 days post i.v.i.g therapy . Further in aug he was again admitted as he suffered from lung infection nd too much weakness in legs . He was treated with 5 vial i.v.i.g and antibiotics and later after 5 days released . Sir he is taking azoran and predisolone but now again he is feeling cough nd litle fever . Sir i am unable to judge why all this happening . Further is there any therapy from which he can get rid of myasthenia instantly . Also sir his immunity is down because of immunosuprents but he catches infections even after we take a lot of precautions . Please suggest us what to do . We can go for any treatment to get rid of this disease . Sir why we take immunosupresents as he is already operated for thymectomy . And how can we cure our father from these infections

Answered by Dr. Sudhir Kumar (6 hours later)

Brief Answer:
Immunosuppresants are needed for 2-5 years postop

Detailed Answer:
Hi,

Thank you for getting back.

I remember your father's details. It is unfortunate that he has got a chest infection. As you already pointed out, he is more prone to develop infections in view of his low immunity (which is due to his immunosuppressants use).

Medications for immunosuppression are needed after thymectomy also, because some amount of antibodies are already there in his system even prior to the surgery. Medications may be needed for about two years after surgery, and in some cases, even up to five years.

He is on correct treatment for myasthenia at present, and we should persist with that line of treatment.

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 hours later)

sir he is taking azoran 50 at day and 100 at night alongwith wysolone 40 od . if his immunity is dat much low then can we reduce this azoran . further is there any process or therapy like blood change after which my fathers antibodies count come to normal . his count was 23 in may nd 17 now but normal is 0.23 . also sir is this disease hereditery as i am diagnosed with one skin disease alopecia areata . sir can myasthenia have more attacks as my father felt 15 days back . sir i want him to get rid of this disease speedy . we cant see our father suffering . further please suggest something to keep him healthy by telling us what to eat and avoid for myasthenia as he is also diabetic now . good night sir and thanks for being so kind

Answered by Dr. Sudhir Kumar (9 minutes later)

Brief Answer:
He is on correct dose of medicines.

Detailed Answer:
Thank you for getting back.

He is on correct doses of azoran and wysolone. Please continue the same as of now.

Blood change such as plasma exchange (or plasmapheresis) is reserved for serious cases of myasthenia gravis (called as myasthenic crisis) and not used in a stable patient of myasthenia. In short, it is an alternative for using IVIG.

Myasthenia can be congenital (can come from affected mothers to babies). However, you would not get it at this adult age.

He should be on normal diet, and do regular exercises including breathing exercises.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj