ABSTRACT
MG is a chronic and even for half of the adequately treated patients, a lifelong disease. The course is inpredictable in the individual patients. As in all chronic diseases the patient has to live with her! disability and most patients succeed in doing so. Many however have to go through a period of uncertainty in which the diagnosis is not made (1, 2) and emotional problems are thought to be the cause of their symptoms. After the diagnosis is made, the patient needs a thorough explanation of the nature of the disease and frequent contact with a doctor who is able to treat her. Many patients complain that their doctors know less of MG than they do them selves, especially if they have become a member of a MG-patient association-Problems may arise if they are treated for other diseases (3). Many patients know that certain drugs may enhance their symptoms (table 4.3), and are critical if a new drug is prescribed or are inclined not to take it. Patients should know that emotions and stress though not the cause of their disease are likely to have great influence upon it, that short periods of rest are effective and vigourous exerci se is to be avoided, and that MG has spontaneous fluctuations, particularly in the first 3 to 5 years. The same knowledge will make doctors somewhat reluctant to change a therapy too soon, or to ascribe any improvement to a new way of treatment. Symptoms may be exacerbated during infections with fever, extreme environmental temperatures (avoid hot baths, sauna, sunbathing), hot foods and in the premenstrual period in about one third of the women. Operations and other medical interventions may also be followed by an exacerbation.I Patients should be advi sed to do what they feel they are able to, without a priori restrictions. Keeping a diary is very helpful for doctor and patient to get a better insight into the factors that influence the symptoms and the effect of therapy. A general outline of treatment is given in table 4.1.
