Suggest treatment for myasthenia gravis

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Posted on Mon, 26 May 2014 in Lupus
Question: Sir my father is being treated in apolo delhi for myasthenia. Earlier he was ok but when we admitted him for thymus operation he was shifted to icu and then he fell into myasthenia crisis as dr said . Sir we believe that they gave him ivig of reliancr company which reacted in him causing plenty of cough nd severity .aftrr three days dr changed brand and used an imported brand of 30000 prr 5gm .total for 5 days he gave 25 vials of 5gm . Now he seems to stabilise . Sir we want to know that is he be cured by medicines or we must get thymus operated . And till when thid therapy of 25 vials will sustain . Can it happen again that he fall in crisis . My father is 65 old nd we are much worried about him
doctor
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
My reply is below.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your father's symptoms and treatment received so far.

Myasthenia gravis (MG) is an auto-immune disease, where antibodies are produced by the thymus gland, making the muscle weaker. Therefore, removal of thymus (thymectomy) is the best treatment, as the source of antibodies is removed, and MG is cured.

IVIG acts temporarily against antibodies and the effect may last for about three months.

A person can go into myasthenic crisis more than once, however, it is not common.

In my opinion, thymectomy should be done once he is stable.

If he is unfit for thymectomy, medications such as prednisolone or mycophenolate may be used to reduce the amount of antibodies.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 36 hours later
thnks for reply sir . how can we know he is stable .our doctor is not willing to operate for next 25 days . we are now worried as someone told us that for operation we again have to go through uvig 25 vial before operation nd 15 vial after operation . sir could u please suggest what we should do . please suggest any best doctor in delhi who is neurologist and also one cardiologist for operation . what should be a complete pacgage of operation nd all
doctor
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
My reply is below.

Detailed Answer:
Thank you for getting back.

If the patient has not breathing problem, no drooping of eyelids, is able to swallow and speak normally and has no arm weakness, then, he would be fit for surgery.

you can meet Dr XXXXXXX XXXXXXX at Apollo New Delhi; or Dr Rajshekher Reddi at XXXXXXX XXXXXXX for second opinion.

Thymectomy can be done by any good cardio-thoracic surgeon.

Cost would differ in various hospital, but would be between 1.5-2 lakhs.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 10 hours later
sir he is still having problem . sometime double vision and not able to speak fluently. also dr giving him myestin 60 .so he is stable for operation or still need some time.is it like we again have to go thru ivig if he is not operated for next 29 days . even after operation is he be cured permanently or disease will have effect . also after operation is there any repeat need of ivig .can he live normal life after operation without medicines working like the way he was before disease or he have to be on rest always . if we r not satisified here den can we come to you at hyderabad . can u give us a complete package from day 1 to last day when he will be discharged after operation as we feel dat we waisted money here at delhi for last 7 days . our dr is dr XXXXXXX XXXXXXX please let me know is he a good enough . please keep this question as a secret as u r too in apolo organisatuon . thanks sir
doctor
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer:
My reply is below.

Detailed Answer:
Thank you for getting back.

I can understand your anxiety, however, I would like to reassure you that there is no need to worry, as myasthenia gravis (MG) is fully curable.

The effect of IVIG injections are usually maintained for three months, so, the operation should be done within that period. The earlier it is done, better it is.

It is not common for patients to require repeated doses of IVIG, however, some people (about 10%) do require repeated doses, especially those with severe myasthenia.

I would be pleased to take care of your father here at Hyderabad Apollo, if you wish so. There is no package as such, it would depend on total number of days in ICU, ward, cost of surgery, need for mechanical ventilator, medications, etc. The total approximate cost for two weeks may be about five lakhs.

Dr XXXXXXX is a XXXXXXX neurologist and you can continue care under him too.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 25 hours later
thanks for reply sir . my last question will be how can i pay again to ask u further questions . also sir juniour dr told us that after operation they will again give him 10 vials of ivig . sir which i feel is not neccesary . also sir is this thmectomy a safe operation and dr XXXXXXX ganjoo is doing that on 9 so is our dr good enough . thanks a lot sir for being a guardian to us in this crucial time .

regards XXXX
doctor
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer:
http://bit.ly/Dr-Sudhir-kumar

Detailed Answer:
Thank you for getting back.

I have given you the link for posting Direct Query to me in my first reply. You can copy that link in a new browser and click on "ask me a question".

Need for further IVIG would depend on patient's condition after surgery. Thymectomy is safe surgery and there are no complications.

The doctors there are good.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Sudhir Kumar

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Practicing since :1994

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