Key messages

• Anticholinesterase drugs are useful in producing a temporary improvement in neurotransmission but are of no benefit to the underlying pathology.

• Anticholinesterase drugs can produce a cholinergic weakness.

• Thymectomy is the treatment of first choice in those in the younger age group.

• Longer-term immunosuppression using steroids or azathioprine alone or in combination is beneficial.

• Temporary reduction of anti-acetylcholine receptor antibody activity can be obtained with plasma exchange and IgG immunoadsorption, or intravenous immunoglobulin.

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