Management principles

• Detect possible presence of thymoma with CT or MR scan of thorax. If present, removal is recommended.

• Thymectomy is recommended early for generalised myasthenia, especially in all younger patients with hyperplasia of the thymus, even if not confirmed preoperatively.

• Plasmapheresis is useful for acute crisis or where temporary improvement is required or patients are resistant to treatment.

• Avoid drugs that are relatively contraindicated.

• Pharmacological agents:

o anticholinesterase drugs, e.g. pyridostigmine, neostigmine or distigmine: should be used only for mild to moderate symptoms o corticosteroids: useful for all grades of MG; should be introduced slowly

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