Treatments for Myasthenia Gravis in Children

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Contact the Neuromuscular Center

A diagnosis of juvenile myastheniagravis (JMG) can be worrisome. You are probably wondering where to go from here and how to make sure your child receives the best possible care.

All of the members of the Neuromuscular Center at Boston Children's Hospital are here to help. Our specialists are dedicated to anticipating any complications that your child may experience from his disease and developing the best therapeutic plans to manage them.

What treatments are available?

Although JMG can't be cured, there are several treatment options that are effective in strengthening muscles, managing symptoms and prolonging symptom-free periods.

Depending on his specific needs, your child may receive one or a combination of a few different treatments:


  • Acetylcholinesterase inhibitors, especially pyridostigmine, are standard drugs that increase acetylcholine neurotransmitter levels. These work well for some children with mild symptoms.
  • Immunomodulatory therapy, which are treatments that reduce the quantity of harmful antibodies in the body. They include:
    • Plasmapheresis: This is used to remove antibodies from the blood. First, blood is removed from your child's body through an intravenous catheter. Plasma containing abnormal antibodies is then separated from the rest of his blood and discarded. Finally, his own cleaned blood is returned to his body through another intravenous catheter.  The discarded antibodies may be replaced by albumin or, in certain cases, plasma from blood donors.
    • Intravenous immunoglobin (IVIG): This works by decreasing the amount of antibodies produced by the immune system, much like plasmopheresis. However, it's easier to administer than plasmopheresis because you only need one, relatively small IV. IVIG is usually effective at helping calm the autoimmune reaction caused by JMG.
    • Steroids: While steroids drugs are usually effective, they have significant side effects. 
    • Less common immunosuppressive drugs can be used in cases where the traditional treatment methods don't work. However, these drugs carry significant side effects and should only be used when other options have been exhausted or are inadvisable.

What are the side effects of steroids?

Children who are on steroids should be carefully monitored by a physician. They may experience:

  • weight gain
  • slow height growth
  • temporary moodiness or other behavioral changes
  • increases in blood pressure and blood sugar
  • calcium deficiency
  • change in facial appearance


Thymectomy is the surgical removal of the thymus gland in the chest.  The thymus has been associated with production of the harmful antibodies, though the exact mechanism by which the thymus promotes this is unclear.

  • A thymectomy needs to be performed when a child has a thymoma, a rare tumor of the thymus.
  • Thymectomy may be used on children with generalized JMG who are not responding to medical treatments, or those who would be heavily dependent on medication in the long term.  Thymectomy is usually not indicated in cases of pure ocular myasthenia (myasthenia that only affects the eyes).
  • This procedure can work very well in some, though not all cases. Based on a number of retrospective studies, it can produce remission from MG, increase strength and reduce the need for medication.
  • The Department of Pediatric Surgery at Boston Children's performs thymectomies and other specialized surgical services to infants, children and adolescents.

Will my child need surgery?

Children with generalized myasthenias who are not responding to medical treatments, or who are heavily dependent on medication, may be eligible for a thymectomy (surgical removal of the thymus). In some cases, children who undergo the procedure improve significantly.

Coping and Support

If your child has just been diagnosed with JMG, this is certainly a stressful time for your family. You are being given lots of new information and are probably feeling overwhelmed. It's normal and acceptable to go through a range of emotions. Fortunately, there is a lot of help available to you.

This list outlines some of our resources at Boston Children's and in the wider community that may be helpful to you:

Resources for families:

  • Boston Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center's services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 5:30 p.m. Please call 617-355-6279 for more information.
  • The Medical Coping Team at Boston Children's Hospital works with teens and their families to help them adjust to the stress caused by chronic illness. Our experienced team of pediatric psychologists, psychiatrists and other mental health professionals provide effective, compassionate evaluation, education, counseling and therapy to help teens cope.

Outside resources:

Please note that neither Boston Children's Hospital nor the Neuromuscular Center at Boston Children's unreservedly endorses all of the information found at the sites listed below.

  • The Muscular Dystrophy Association provides information about muscular dystrophies as well as many other neuromuscular diseases at their website. The site also gives a lot of information about services, support for your family and research.
  • The Myasthenia Gravis Foundation of America (MGFA) is focused on advocating optimal diagnosis and treatment for individuals affected by MG.  The MGFA website offers educational resources, community support and opportunities for volunteer work. 
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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