it's another one of those questions that was not properly reserached regarding MG.

what percent of patients will have progression of their illness if they do not recieve immunosupressive treatment?

I fully agree with you that it is not reasonable to take medications with significant side effects, just so that you could get back to your pre-MG state (and no one promises that even with that you will have full recovery).

but, what if you knew that half of the patients that don't get treated will have severe progression of their disease within a few years? obviously, you would think differently.

on the other hand if you knew that it was extremely rare for that to happen, you may still prefer to take that chance then deal with the short and long term side effects of immunosupressive treatment.

Osserman (at the time there was no immunosupressive treatment) described a sub-group of patients that develop severe MG years after they had very mild symptoms. but, he does not give their relative number in the MG population.

also to the best of my knowledge there is no research that was done, finding prognostic factor that can indicate who will and who will not progress without treatment.

it seems though that patients that have been ill for many years, respond less well to treatment then those that are newly diagnosed. and that patients with occular MG who were given steroids (even at a relatively low dose) have less progression to generalized that those that did not. but, even this is based on very limited data, from small patient groups, that were studied in retrospect.

I think that there is no real risk/benefit assesment of MG treatment, and each neurologist or patient decide regarding it, based on very little data, and mostly their gut feeling, which may be right or wrong.