Myasthenia Gravis: Treatment Options (Nursing)

00:01 Okay, so if I have this myasthenia gravis, what are my options for treatment? Well, one is a thymectomy.

00:07 Now why would we do that? We remember some patients with myasthenia gravis, they've got some things going on with that thymus gland.

00:15 And if they consider removing that thymus gland, it can reduce their symptoms and may cure some people.

00:21 It may kind of a rebalance to the immune system.

00:24 But we've got some studies that found that a thymectomy is beneficial both for people with thymoma and people who don't have tumors.

00:31 So you may see a patient that has a known thymoma or one that doesn't, and the decision will be made to remove their thymus gland.

00:39 So that's why we included it here as an option for treatment.

00:42 So a thymectomy-- Oh, cool, there's more medical terminology for you.

00:47 "ectomy" means removal, right? "Hysterectomy" is "ectomy" removing the "hustera", the uterus.

00:55 This is an "ectomy" removing the thymus gland.

00:59 Now we can also use some anticholinesterase medications.

01:04 Okay, "anti" means against.

01:07 "Cholinesterase..." Oh, cool.

01:10 Okay, so A-S-E means an enzyme.

01:13 Enzymes' jobs are to break things down.

01:16 So, if I get medication that is "anti," against, the enzyme breaking down, what's in the middle? Yeah, choline.

01:25 So these are medications that will help more acetylcholine be available because they will block those enzymes that typically break it down.

01:36 The idea is if I have more acetylcholine at the junction, then I'll have better use of the skeletal muscles.

01:42 Immunosuppressive drugs.

01:44 Now before you read our words, what would make sense? What do you know about myasthenia gravis? How would an immunosuppressive drug work? Well, since it's an autoimmune disorder, the body turning on itself, the immunosuppressive drugs will help deal with that.

02:01 They help suppress the production of abnormal antibodies.

02:04 So, we can look at prednisone, azathioprine, a whole list of medications that might help this patient.

02:10 but keep in mind, there's a price for these drugs, and I'm not talking about money.

02:15 Any time you suppress the immune system, we don't just suppress the part that deals with myasthenia gravis, it suppresses their whole immune system.

02:24 It also gives you the side effects of the steroids.

02:28 So, you're going to have to work with your patient to educate them, what side effects to look for, and also so they're aware that there's going to be some changes in your body depending on how much of the steroid the patient has to take.

02:40 They're also going to be at a risk for infection because we're suppressing their immune system.

02:46 These patients are going to be really at risk for developing immune problems when they're exposed to people, like the flu, like the cold, because they don't have an immune system to fight those off if we're suppressing it, trying to deal with their myasthenia gravis.

03:01 Now you can also do plasmapheresis or some IV immunoglobulin.

03:06 Well, that's pretty cool.

03:08 But we just use these in severe cases of myasthenia gravis.

03:12 So, if they have these antibodies in their blood, the plasmapheresis will help us filter those out.

03:19 So plasmapheresis will help remove those destructive antibodies, but it only lasts for a few weeks to months.

03:26 So, it's something that would have to be repeated.

03:28 But keep in mind, we just use these for more severe cases.

03:32 Now in plasmapheresis, they use a machine, they take your blood out, they filter it, kind of think of it that way to try to get rid of the harmful antibodies, and replace the good plasma or use a plasma substitute.

03:43 IV immunoglobulin are like a highly-concentrated injection of antibodies.

03:48 So they've taken multiple donors, pooled their healthy antibodies, and then they put them into a receiver, a patient who has myasthenia gravis.

03:57 So, this will temporarily change the way the immune system operates.

04:01 So it'd be great if we found a permanent solution, but the IV immunoglobulins are also a temporary solution.

04:08 So we've got plasmapheresis which will take the blood out, filter it, get those nasty antibodies out, and put the plasma back in, or use a plasma replacement, and we have IV immunoglobulin.

04:20 So we've taken the really good antibodies from lots and lots of donors, and we've compacted them together, concentrated them together, and we'll inject them into a patient with myasthenia gravis who has pretty serious symptoms.

04:32 Both are temporary.