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  #1  
Old 09-21-2012
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Question Myasthenia Gravis Treatment not working anymore

A 78 year old man present to your office. He has past history of double vision which becomes worse throughout the day. He also complain of decreased ability to finish his meals. He is currently managed with pyridostigmine at the maximal dose for the past year. He has a decreased response to medication. Which of the following is the next step in management ?

A. Cyclophoshamide
B. Cyclosporine
C. Methotrexate
D. Sirolimus
E. Thymectomy
F. Prednisone
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Old 09-22-2012
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I would go for F Prednisolone as Age is not fitting for thymectomy...
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Old 09-22-2012
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F here...........next best would be steroids before trying for immunosuppresents and thymectomy
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Old 09-22-2012
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I just think if your primary drug is not working try steroid then...
So F. Prednisone
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Old 09-22-2012
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Prednisone

then to wean off prednisone either choice A or Azathioprine is the best choice.
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Old 09-22-2012
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F. Prednisone
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Old 09-23-2012
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Answer F Prednisone

Thymectomy is effective in patients under 60 years.by the time patient is older thymectomy will not be effective .in those patients, long term control is afforded by immunosuppressive medication such as prednisone.Over time,after the first 1-2 months when steroids have been effective ,it is important to wean off steroids with other immuno suppressive drugs with less adverse effects such as cyclophosphamide ,azathioprine and sirolimus. However,you should start with steroids
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