How to manage myasthenia gravis and viral infection at 80?

Question

Hi doctor,

My mother is 80 years old. She has had myasthenia gravis for the last 10 years, and it has been under good control. She took only the Distinon tablet three times a day till last month. One month ago, she had a viral fever. She was admitted in hospital for 10 days, and the doctors treated her for pre-crisis myasthenia gravis (MG) and chikungunya.

She was discharged after treatment. For the last three weeks, she has been in bed with continuing physiotherapy, but the recovery is taking time. At the time of discharge, she was advised on the following medicines, which we have continued to date. Distinon increased to four times a day, Azoran once daily, and Tilstigmin (Neostigmine) thrice daily.

Do we need to continue with the medicine, or should we reduce the dosage?
Till when does she need to continue it?
Would she come back to her old dosage soon?
Lastly, what is the recovery time for a chikungunya along with MG in an old patient?

Please suggest.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I agree that the dosages have been increased quite a bit. But, the myasthenia precrisis is treated this way only. Coexisting viral fever in chikungunya may be the added reason to increase the doses on the higher side. If it were an overdose, she would have experienced the symptoms at the time of starting the doses themselves.

Theside effect, if present, will be quite significant, such as smaller pupils, impairment of far sight, hypotension, bradycardia, excessive salivation, frequency of stools, and so on. If she has these symptoms, then we should consider reducing the dose. Otherwise, we should continue the same.

The Azoran (Azathioprine) is an immunosuppressive drug that tries to control the basic pathology of myasthenia. It is an autoimmune response. Regarding recovery, at this age and with these comorbidities, she will take time to improve. But make sure that she receives good and frequent physiotherapy. Honestly, it is unrealistic to predict the exact time frame.

I hope this helps.

For further concerns, do reach out to me anytime.

Thank you.