A Comparison of the Effectiveness of Intravenous Immunoglobulin and Plasma Exchange as Preoperative Therapy of Myasthenia Gravis

Jensen, P; Bril, Vera

doi:10.1097/cnd.0b013e3181660807

Cited by 48 publications

(29 citation statements)

References 8 publications

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“…PE may probably have a more predictable response than IVIg during crisis. IVIg and PE are equally effective in preparation for surgery 56 . In conclusion, until now there is not enough evidence of high quality to support one therapy over another during MC.…”

Section: Plasmapheresis or Immunoglobulin?mentioning

confidence: 99%

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

Godoy

Mello

Masotti³

et al. 2013

Arq. Neuro-Psiquiatr.

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Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC) is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation. MC is a very important, serious, and reversible neurological emergency that affects 20-30% of the myasthenic patients, usually within the first year of illness and maybe the debut form of the disease. Most patients have a predisposing factor that triggers the crisis, generally an infection of the respiratory tract. Immunoglobulins, plasma exchange, and steroids are the cornerstones of immunotherapy. Today with the modern neurocritical care, mortality rate of MC is less than 5%.Key words: myasthenic crisis, myasthenia gravis, respiratory failure, immunosupressive therapy, thymectomy. ReSUMOMiastenia grave (MG) é um distúbio autoimune que afeta principalmente a transmissão neuromuscular, levando a fraqueza muscular generalizada ou localizada. É devida mais frequentemente à presença de auto-anticorpos anti-receptores de acetilcolina na fenda pós-sináptica da placa motora. A crise miastênica (CM) é uma complicação da MG caracterizada por piora da fraqueza muscular, resultando en falência respiratória, o que requer entubação endotraqueal e ventilação mecânica.Isto ocorre também em pacientes pós-cirúrgicos, em que há piora da fraqueza muscular devido à MG, causando um atraso na extubação. MC é uma emergência neurológica importante, séria e reversível que afeta 20-30% dos pacientes miastênicos, usualmente duranteo primeiro ano de enfermidade, podendo a crise miastênica ser a manifestação inicial da MG. A maioria dos pacientes tem fatores predisponentes que desencadeiam a crise, geralmente uma infecção do trato respiratório. Imunoglobulina, plasmaférese e esteróides são a pedra angular da imunoterapia. Hoje, dentro da terapia neurocrítica, a taxa de mortalidade na CM é menor que 5%.

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Section: Plasmapheresis or Immunoglobulin?mentioning

confidence: 99%

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

Godoy

Mello

Masotti³

et al. 2013

Arq. Neuro-Psiquiatr.

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“…It involves intravenous infusion of about 0.4 g/ kg/day of immunoglobulins for 5 days. High-dose immunoglobulin therapy, compared with immunoadsorption (IA), does not require special equipment, but effectiveness equal to that of IA may be expected [113,114]. Huang et al, in 12 MG patients with generalized MG (Osserman type 2B) who were treated by the high-dose administration of immunoglobulin, reported the following: (1) its effectiveness appeared at 3 days on average (range, 1-9 days) after starting the treatment and reached its maximum at 7 days on average (range, 3-19 days); and (2) 6 of these patients, who were also treated by thymectomy, recovered after surgery without any complications [115].…”

Section: High-dose Immunoglobulinsmentioning

confidence: 99%

Perioperative management in myasthenia gravis: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014

Kadota

Horio

Mori

et al. 2015

Gen Thorac Cardiovasc Surg

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Thymectomy is regarded as a useful therapeutic option for myasthenia gravis (MG), though perioperative management in MG patients is largely empirical. While evidence-based medicine is limited in the perioperative management of MG patients, treatment guidelines are required as a benchmark. We selected issues faced by physicians in clinical practice in the perioperative management of extended thymectomy for MG, and examined them with a review of the literature. The present guidelines have reached the stage of consensus within the Japanese Association for Chest Surgery.

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“…Ved stabil sykdom bør man bruke annen immunterapi hvis nødven-dig, som for eksempel prednisolon og azatioprin, og symptomatisk behandling med pyridostigmin. Intravenøs IgG-behandling kan brukes på lik linje med plasmautskiftning preoperativt før tymektomi (19).…”

Section: Nevromuskulaere Transmisjonssykdommerunclassified

Intravenøs IgG-behandling av nevromuskulære sykdommer

Vedeler¹,

Mellgren²,

Omdal³

et al. 2010

Tidsskriftet

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A Comparison of the Effectiveness of Intravenous Immunoglobulin and Plasma Exchange as Preoperative Therapy of Myasthenia Gravis

Abstract: The results show that intravenous immunoglobulin may have comparable efficacy in the preoperative preparation of patients with myasthenia gravis and that this therapy is a reasonable alternative to plasma exchange in this clinical setting.

Cited by 48 publications

References 8 publications

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

Perioperative management in myasthenia gravis: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014

Intravenøs IgG-behandling av nevromuskulære sykdommer

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