Fluctuating symptoms are a defining feature of myasthenia gravis (MG). Symptoms may get better or worse throughout the day, for a few weeks — or sometimes longer. The long-term improvement of MG symptoms is possible, but it’s unpredictable, and often doesn’t last.
What is remission?
Remission means that MG symptoms have significantly reduced, or disappeared altogether. Around 40% of people living with MG achieve remission, but it’s not usually permanent: only 10% to 20% of people achieve long-term remission. More often, remission may last for several years, followed by a relapse and the reemergence of MG symptoms. Patients who are diagnosed with MG within the first year after their symptoms start and who were under 40 when their symptoms started are more likely to achieve remission.
There are three main types of remission in MG according to the Myasthenia Gravis Foundation of America:
- Complete stable remission: This describes when symptoms completely disappear, and no treatment has been needed for at least a year.
- Pharmacological remission: In this type of remission, a patient’s symptoms are completely controlled by medication.
- Minimal manifestation: This describes when MG symptoms are still present, but are mild and have a low impact on daily life.
Learn more about MG prognosis
How is clinical remission achieved in MG?
Remission is difficult to predict and is not possible for all MG patients. Clinical remission doesn’t usually occur spontaneously in MG, but as a result of treatment.
There is no single treatment to achieve remission, however. The best treatment plan for any patient will depend on a variety of factors, such as their age and MG subtype. Treatment might take the form of immunosuppressive therapy, cholinesterase inhibitors, corticosteroids, intravenous immunoglobulin (IVIG) or surgery to remove the thymus, called thymectomy. Notably, roughly 30% to 40% of patients who have a thymectomy achieve remission, but the surgery isn’t right for everyone: it’s usually recommended for those who have a thymoma (thymus tumor), are positive for acetylcholine receptor (AChR) antibodies and are under age 50.
If you achieve remission, it doesn’t mean you don’t need to think about MG anymore: you’ll still need long-term close monitoring, in case a relapse occurs. In cases of pharmacological remission, you’ll need to be consistent in taking medication.
Why don’t all patients with MG go into remission?
Doctors don’t completely understand why some patients reach remission and others don’t; more research is needed to better predict what patients can expect. However, these are some common reasons patients don’t achieve remission:
- Subtype of MG: Generalized MG is less likely to enter remission than ocular MG.
- Late onset: Older patients don’t respond as well to treatment.
- Late diagnosis: The disease may have progressed without treatment.
- Delayed treatment: Long delays impact the effectiveness of treatment.
- Autoantibody status: Certain antibodies are less likely to allow remission.
- Other pre-existing health conditions.
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