Acquired myasthenia gravis (MG) is a chronic autoimmune disorder of the 
neuromuscular junction, characterized clinically by muscle weakness and abnormal 
fatigability on exertion. Current guidelines and recommendations for MG 
treatment are based largely on clinical experience, retrospective analyses and 
expert consensus. Available therapies include oral acetylcholinesterase (AChE) 
inhibitors for symptomatic treatment, and short- and long-term disease-modifying 
treatments. This review focuses on treatment of MG, mainly on the use of the 
AChE inhibitor pyridostigmine. Despite a lack of data from well controlled 
clinical trials to support their use, AChE inhibitors, of which pyridostigmine 
is the most commonly used, are recommended as first-line therapy for MG. 
Pyridostigmine has been used as a treatment for MG for over 50 years and is 
generally considered safe. It is suitable as a long-term treatment in patients 
with generalized non-progressive milder disease, and as an adjunctive therapy in 
patients with severe disease who are also receiving immunotherapy. Novel AChE 
inhibitors with oral antisense oligonucleotides have been developed and 
preliminary results appear to be promising. In general, however, AChE inhibitors 
provide only partial benefit and most patients eventually switch to long-term 
immunosuppressive therapies, most frequently corticosteroids and/or 
azathioprine. Although AChE inhibitors are known to be well tolerated and 
effective in relieving the symptoms of MG, further efforts are required to 
improve treatment options for the management of this disorder.