Treatment of myasthenia gravis with methylprednisolone pulse: a double blind study

Lindberg, Carl; Andersen, Oluf; Lefvert, Ann‐Kari

doi:10.1111/j.1600-0404.1998.tb05968.x

Cited by 90 publications

(48 citation statements)

References 21 publications

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“…These results indicate that IA + HMP for a longer interval (mean, 151 days) is more effective than IA alone for a shorter interval (mean, 29 days). Although we did not compare the effects of IA + HMP and HMP alone in the present study, previous studies have reported that the effect of HMP continued for only 4-14 weeks [16], and that even frequent repetition of HMP (every fifth day intravenous administration of 2,000 mg of methylprednisolone) did not result in complete remission of MG symptoms [17]. In contrast, 4 of the present patients receiving IA + HMP demonstrated remission (no symptom with no medication for more than 1 year).…”

mentioning

confidence: 81%

The Effect of Combined Therapy with Immunoadsorption and High-Dose Intravenous Methylprednisolone on Myasthenia gravis

Munakata¹,

Utsugisawa

Nagane

et al. 2002

Eur Neurol

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mentioning

confidence: 81%

The Effect of Combined Therapy with Immunoadsorption and High-Dose Intravenous Methylprednisolone on Myasthenia gravis

Munakata¹,

Utsugisawa

Nagane

et al. 2002

Eur Neurol

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“…IV methylprednisolone (IVMP), IV immune globulin (IVIg), and plasma exchange are accepted and safe therapies for patients with suspected autoimmune neurologic disorders. [16][17][18][19] Their use as part of a diagnostic algorithm has been advocated but not formally evaluated. [20][21][22] Response to an immunotherapy trial can support the diagnosis of autoimmune epilepsy 21,22 and can help identify those most likely to respond to maintenance immunosuppressive therapy.…”

mentioning

confidence: 99%

Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy

et al. 2014

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Objective: To evaluate a trial of immunotherapy as an aid to diagnosis in suspected autoimmune epilepsy. Method:We reviewed the charts of 110 patients seen at our autoimmune neurology clinic with seizures as a chief complaint. Twenty-nine patients met the following inclusion criteria: (1) autoimmune epilepsy suspected based on the presence of $1 neural autoantibody (n 5 23), personal or family history or physical stigmata of autoimmunity, and frequent or medically intractable seizures; and (2) initiated a 6-to 12-week trial of IV methylprednisolone (IVMP), IV immune globulin (IVIg), or both. Patients were defined as responders if there was a 50% or greater reduction in seizure frequency.Results: Eighteen patients (62%) responded, of whom 10 (34%) became seizure-free; 52% improved with the first agent. Of those receiving a second agent after not responding to the first, 43% improved. A favorable response correlated with shorter interval between symptom onset and treatment initiation (median 9.5 vs 22 months; p 5 0.048). Responders included 14/16 (87.5%) patients with antibodies to plasma membrane antigens, 2/6 (33%) patients seropositive for glutamic acid decarboxylase 65 antibodies, and 2/6 (33%) patients without detectable antibodies. Of 13 responders followed for more than 6 months after initiating long-term oral immunosuppression, response was sustained in 11 (85%).Conclusions: These retrospective findings justify consideration of a trial of immunotherapy in patients with suspected autoimmune epilepsy. Classification of evidence:This study provides Class IV evidence that in patients with suspected autoimmune epilepsy, IVMP, IVIg, or both improve seizure control. Neurology ® 2014;82:1578-1586 GLOSSARY AED 5 antiepileptic drug; CASPR2 5 contactin-associated protein-like 2; CC 5 calcium channel; gAChR 5 neuronal acetylcholine receptor, ganglionic-type; GAD65 5 glutamic acid decarboxylase 65; IgG 5 immunoglobulin G; IVIg 5 IV immune globulin; IVMP 5 IV methylprednisolone; LGI1 5 leucine-rich, glioma-inactivated 1; PMA Abs 5 antibodies to neural plasma membrane antigen; VGKC 5 voltage-gated potassium channel.Approximately one-third of epilepsy cases are intractable to antiepileptic drug (AED) therapy.

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“…The advantage of postoperative immunosuppressant therapy was affirmed by the study conducted by Lindberg et al [7] and Ponseti et al [17] . In a doubleblind, placebo-controlled study, a thymectomy was performed more than 6 months prior to the investigation, and 80% (8/10) of patients undergoing the postoperative single methylprednisolone pulse therapy exhibited a significant improvement in myasthenic muscle score over a 14-week observation period [7] .…”

Section: Discussionmentioning

confidence: 61%

Outcomes of Preoperative and Postoperative Corticosteroid Therapies in Myasthenia Gravis

Yun

Liu

et al. 2017

Eur Neurol

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Aims: To compare the long-term outcomes of non-thymomatous myasthenia gravis (MG) patients receiving pre-thymectomy (Pre-CS) or post-thymectomy corticosteroid (Post-CS) therapy. Methods: In a retrospective cohort study, 41 patients with MG were treated with Pre-CS therapy, and 110 were treated with Post-CS therapy. Results: In the MG cohorts, 9 of 40 patients (22.5%) in the Pre-CS group vs. 28 of 105 patients (26.7%) in the Post-CS group achieved a complete remission (CR) at 1 year, 29.7% (11/37) vs. 38.6% (32/83) at 2 years and 36.4% (8/22) in the Pre-CS group vs. 50.0% (28/56) in the Post-CS group achieved a CR at 5 years. For the entire population, Post-CS therapy (hazard rate [HR] 3.042, p = 0.020) was a positive predictor for remission, and a long preoperative interval (HR 0.936, p = 0.030) was a negative predictor. In 98 original ocular MG patients, Post-CS therapy (HR 2.663, p = 0.014) and an age at onset ≥15 years (HR 4.865, p = 0.001) were positive predictors for remission. Discussion: Post-CS therapy with a shorter preoperative interval increases the likelihood of CR in postpubertal and adult patients.

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Treatment of myasthenia gravis with methylprednisolone pulse: a double blind study

Abstract: We conclude that a single IVMP treatment is efficacious and safe in the treatment of moderate MG.

Cited by 90 publications

References 21 publications

The Effect of Combined Therapy with Immunoadsorption and High-Dose Intravenous Methylprednisolone on Myasthenia gravis

The Effect of Combined Therapy with Immunoadsorption and High-Dose Intravenous Methylprednisolone on Myasthenia gravis

Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy

Outcomes of Preoperative and Postoperative Corticosteroid Therapies in Myasthenia Gravis

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