Myasthenia Gravis Learning Zone
Transcript: MG podcast series summary: Key insights
Nils Erik Gilhus, MD, PhD
Interview recorded June 2026. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
- Hello. Together with Medthority we have recorded a podcast series, Unlocking Myasthenia Gravis, where we have discussed with experts on selected topics. Today I will try to sum up and give some main conclusions of this work. A typical aspect of myasthenia gravis is variability. It is fluctuations during the day, from day to day, and, more important, risk exacerbations that can be severe and even life threatening. Such exacerbations can be triggered, but also come without any obvious triggering factors. Infections are the most common triggers, perhaps also stress, more difficult to define.
And in women, hormones, for example, during pregnancy or related to the menstruation cycle can be relevant and important triggers that sometimes can be avoided, or perhaps treated. Medications, new medications can also trigger deterioration and severe exacerbation in myasthenia gravis patients, but this is individual.
These responses varies between patients. Most important deterioration is a crisis with respiratory insufficiency and need of intensive care treatment, most commonly with respiratory infections. So the aim of the treatment is to be proactive, to treat efficiently so that exacerbations are avoided, and also trying to avoid known triggers.
There are luckily many new treatments that improves the situation, but still from today's studies, there is an annual risk of myasthenia crisis in an individual patient of one to 2%, and a lifetime risk of at least 10%. Treatment goals should be ambitious. One should have ambition and the patient should have an ambition of minimal symptoms only or even pharmacological improvement with no symptoms at all. Also, in addition to symptom control, it is an aim to control the disease itself. There are several treatments, and there is an increasing use of new treatments, such as complement inhibitors and FcRn inhibitors.
Also, B-cell therapies and T cell therapies are important. Such therapies will define target in the immune system, although they are not specific for the acetylcholine or MuSK-directed immune response. In addition to this active treatment effect, it is important trying to avoid side effects that are common, for example, with corticosteroids. There is also an important aspect that many patients are elderly. Most, the majority, are above 65 years, also those with long-standing myasthenia and those with debut of their myasthenia. This is relevant for comorbidities and polypharmacy. In this treatment of myasthenia gravis, the active cooperation with the patient is most important.
This communication can be digital but also personal. The follow-up of patients is based on what patient tell you, what you can find with your examination, but most important are patient-reported symptoms. And there are as well assessment scales for these examinations, MG-ADL, QMG, and also quality of life are important parameters well known in the follow-up of myasthenia gravis patients. And by such follow-up, it is possible to recognize early warning signs for the patient, and also to give a broader support and follow-up of the patients. So I think the conclusion on this podcast series, the main conclusion is that you should treat actively and ambitiously, that you should use all treatments, all drugs that are available in your center, in your hospital, in your country.
You might often combine them and you should follow-up the patient and listen to the patients during the whole time period of their myasthenia gravis. Thank you for watching this video.
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