The serologic diagnosis of MG is made by detecting AChR antibodies with a radioimmunoprecipitation assay. Generally, AChR antibody titers do not correlate with clinical severity. The term gravis is now a misnomer because MG responds fairly well to the available therapies. Although the sequence of application of the various therapeutic modalities may differ among physicians, the initial choice in mild cases is generally an anticholinesterase drug every four hours while the patient is awake. Thymectomy is done in most centers through the transsternal approach in patients beyond puberty and up to 60 years of age.
Prednisone is the first-line immunotherapeutic drug therapy.
The preferred dosage is 60 to 80 mg as a single daily dose in the morning for an initial period of three to four weeks. Ig is generally reserved for crisis and severe cases and to strengthen a patient before thymectomy. Cyclosporine or azathioprine may be used as a second-line therapy. LEMS occurs more frequently in men than women. Approximately 70 percent of men with LEMS have SCLC, as compared with 20 percent of women.