Treatment for myasthenia gravis should be individualized to each patient based 
on the clinical characteristics of myasthenia including the distribution, 
duration, and severity of weakness and resulting functional impairment; the 
risks for treatment complications related to age, gender, and medical 
comorbidities; and the presence of thymoma. Acetylcholinesterase inhibitors 
provide temporary, symptomatic treatment for all forms of myasthenia gravis. 
Immune modulators address the underlying autoimmune process in myasthenia 
gravis, but are associated with potential complications and side effects. Most 
patients with generalized myasthenia who have significant weakness beyond the 
ocular muscles and who remain symptomatic, despite treatment with cholinesterase 
inhibitors, are candidates for immune modulation. Although corticosteroids are 
effective for long-term immune modulation in myasthenia gravis, several more 
contemporary immunomodulators including azathioprine, cyclosporine, and 
mycophenolate mofetil have shown efficacy in myasthenia gravis and are used 
increasingly as first-line treatments and as steroid-sparing agents. Plasma 
exchange is used to achieve rapid improvement in patients with myasthenic crisis 
or exacerbation, to improve strength before a surgical procedure or thymectomy, 
and to minimize steroid-induced exacerbation in patients with oropharyngeal or 
respiratory muscle weakness. Intravenous immunoglobulin represents an 
alternative to plasma exchange in patients requiring relatively rapid short-term 
improvement in the setting of poor venous access. Because of a lack of 
controlled trials, the role of thymectomy in nonthymomatous myasthenia gravis is 
unclear, although evidence suggests that thymectomy increases the probability 
for myasthenic remission or improvement.