Prednisone and Myasthenia Gravis
by Christopher Glisson, D.O.
Myasthenia gravis [MG] (both ocular and generalized) is an autoimmune disease. Autoimmune disease occurs when the body overproduces specific antibodies that cause undesirable side effects. In MG, antibodies to a specific receptor on the muscle membrane interfere with communication from the nerves. As an autoimmune disease, the symptoms of MG can often be minimized by altering the body's immune system.
Several medications can be used for immunosuppression (changing the activity of the immune system with the goal of reducing disease activity and reducing symptoms). While several newer agents are gaining popularity in the treatment of MG, prednisone has been the most commonly used.
Prednisone (commonly referred to as a "steroid") is a synthetic hormone very similar to cortisone, which the body naturally produces. It is used to treat a variety of diseases and conditions, and has a strong anti-inflammatory effect. In myasthenia, prednisone works by reducing the activity of the body's immune system, thus decreasing the number of antibodies in the bloodstream that interfere with communication between the nerves and muscles. Prednisone can dramatically decrease the symptoms of myasthenia gravis. Some studies have suggested that marked improvement, or even resolution of symptoms, can occur in up to 75% of patients treated with steroids. The most significant improvement usually occurs within the first 6-8 weeks, but some improvement can occur weeks-to-months later.
While many people are reluctant to consider the use of prednisone due to the well-publicized side effects, it is important to remember that this medication has been used safely and effectively for MG (and a host of other conditions) for decades. However, you and your physician should work toward identifying the lowest effective dose necessary to manage symptoms, keeping in mind that this dose may change with time and with a number of other factors. As with other treatments for myasthenia, it is also important to remember that every patient will respond differently; each individual's regimen should be specifically designed for them by their health care provider, and carefully monitored over time for any necessary changes.
Prednisone is one of several medications that are effective in managing the symptoms of MG. As our understanding of autoimmune diseases improves, we have ever-increasing reasons for optimism about the possibility of managing symptoms, and preserving quality of life for our patients.