Thought leaders review the role of non-pharmacological strategies to manage myasthenia gravis comorbidities.
Dr. James F. Howard: Are there non-pharmacologic strategies that you use?
Dr. Nicholas J. Silvestri: Yeah. I think in certain circumstances. I think one of the common comorbidities, for example, in MG is obstructive sleep apnea. And oftentimes patients talk about fatigue and other symptoms of obstructive sleep apnea and put people through sleep studies. And if it's there, which it is a lot of times in patients with MG, we’ll use BiPAP at night as a good non-pharmacological approach, which often that has the dual benefit of not making people only feel better because of the underlying obstructive sleep apnea, but any component or any contribution it was having in aggravating their myasthenia has been resolved too. A lot of people have been happy with that once they find the MuSK they like. And then exercise. Again, I think that we're blessed to have physical therapists in our area that understand the disease and really can work with patients to tailor a program for them that's not going to harm them in any way. Recommending an overall healthy lifestyle, but exercise for many patients I think is important as well.
Dr. James F. Howard: I agree completely. And I believe every myasthenic who has generalized disease needs a sleep study. And what we're finding is those with MuSk myasthenia have lots of hypoventilation and require O2 supplementation in contrast to those with ACHR positive, for instance. Not to say the others don't sometimes get it, but overwhelmingly our MuSK population is at high risk for this. Physical therapy has been shown to be beneficial with increasing endurance, improving respiratory parameters. The other one that I like a lot though it's becoming harder to implement is those with ptosis is using an eyelid crutch which is a little U-shaped Bain that gets welded into the frame that just pulls up the eyelid. And I like that better than tape because tape seemingly stretches the skin and then they get a lot of excess tissue hanging down that becomes a revolving circle with no ending in sight. But the crutch I've found very helpful. It takes a little getting used to, to wear, but patients should discuss with their eye physician. And sometimes it's the optometrist rather than the ophthalmologist who knows where to get this done.
Transcript Edited for Clarity