What Causes Remission in Myasthenia Gravis?
Myasthenia gravis (MG) is a rare, autoimmune disease that causes a person’s muscles to become weak and to tire easily. The way the disease develops is different for each person. However, most symptoms of MG can be treated. In some people, symptoms will disappear altogether for a period of time. This is called remission.
What is remission?
According to the Myasthenia Gravis Foundation of America (MGFA) Task Force, remission happens when a person with MG has no signs or symptoms of the condition.1
Remission is different from what the MGFA Task Force calls minimal manifestation status (MMS). MMS is when a person with MG has no symptoms or limits to their abilities, but they still have some muscle weakness.1
How does it occur?
Doctors are not sure what causes remission to happen. In some cases, it can occur with no explanation, though this is rare.2
Sometimes, a surgery called a thymectomy can lead to remission. Some medicines may also lead to remission, but they are mostly used to treat the symptoms of MG and not cure it. Some of the main treatments for MG include:3
- Acetylcholinesterase inhibitors, a type of fast-acting drug that improves nerve signals to the muscles.
- Steroids, a type of hormone used to control MG symptoms quickly when acetylcholinesterase inhibitors are not enough
- Immunotherapies, which can make the immune system less active or act differently
More research is needed to figure out what causes remission in MG. In most cases, remission is not something that happens overnight. It can take months or even years to see remission with medicines or surgery.
What is a thymectomy?
Thymectomy is a surgical procedure that removes the thymus gland. The thymus gland is located in your chest just over your heart. It does most of its work in early childhood and helps your body to make antibodies.4
Most people’s thymus gland shrinks as they get older, but sometimes the thymus gland stays large and active. Doctors think that the continued activity of the thymus gland in people with MG plays a role in the disease.5
About 10 percent of people with MG have a tumor on their thymus gland. This is called a thymoma. In many cases, thymomas are benign, or not harmful.4
What does the research say?
One study from 2014 found that the people most likely to go into remission after thymectomy were those with mild MG. Another study in 2016 compared people with MG who had a thymectomy and were taking prednisone to those who were only taking prednisone.
While the study did not focus on remission, it found that people who had a thymectomy had better outcomes than those who were on prednisone alone.2,6
In 2020, the MGFA Task Force updated its recommendations for thymectomy. The Task Force continues to recommend a thymectomy for any people with a thymoma. The recommendations also suggest that thymectomy should be considered early in the disease for more positive results.7
However, it is important to keep in mind that remission does not happen shortly after a thymectomy. It can take months or years for symptoms to completely go away.
Lifestyle and disease management
Since doctors are not sure what causes remission or how long it will last for each person, you should follow the same basic wellness plan during remission that you did during active treatment. These steps can help you:8-10
- Eat a healthy diet and maintain a healthy weight
- Exercise, within your limits
- Get plenty of sleep
- Pace your activities and conserve energy when you can
- Avoid extreme temperatures (hot or cold)
- Maintain a good support network and ask for help when you need it
Talk to your doctor about how often you will need to see them when you are in remission.
Have you found it difficult to discuss your diagnosis or symptoms with loved ones?