Clinical trial of plasma exchange and high‐dose intravenous immunoglobulin in myasthenia gravis

Gajdos, Philippe; Chevret, Sylvie; Clair, Bernard; Tranchant, C.; Chastang, Claude

doi:10.1002/ana.410410615

Cited by 487 publications

(354 citation statements)

References 20 publications

Supporting

Mentioning

318

Contrasting

Unclassified

Order By: Relevance

“…In our case, although polyvalent antibodies were applied, radical improvement was observed after two plasma exchange procedures. The complications that could be attributed to plasmapheresis were slight, and discontinuation of the procedures was not necessary, as in the cases described in the literature [3,6]. Moreover, the amount of plasma exchanged at any one time was higher in our patient (3254, 2662 mL) compared to the case reported in literature, which also affected the efficacy of plasmapheresis [3].…”

Section: Discussionsupporting

confidence: 57%

“…One of the few prospective, randomised studies (which was carried out on a group of 87 patients) did not indicate a significant difference in the clinical improvement between patients treated with high doses of immunoglobulins and those administered plasmapheresis. According to advocates of immunotherapy, high doses of immunoglobulins (0.4 g kg -1 day -1 for 5 days) are equally effective and carry a lower risk of complications [6]. In our case, although polyvalent antibodies were applied, radical improvement was observed after two plasma exchange procedures.…”

Section: Discussionmentioning

confidence: 52%

“…Several cases of adult patients undergoing plasmapheresis have been described [3,5]. Only a few studies have compared the effectiveness of non-specific antibodies and plasma exchange [6,7]. One of the few prospective, randomised studies (which was carried out on a group of 87 patients) did not indicate a significant difference in the clinical improvement between patients treated with high doses of immunoglobulins and those administered plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Postępowanie u dziecka w przełomie miastenicznym

Rybojad¹,

Lesiuk²,

Fijałkowska-Nestorowicz³

et al. 2013

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.Key words: myasthenia gravis, children; myasthenia gravis, myasthenic crisis; myasthenia gravis, general anaesthesia; myasthenic crisis, management; myasthenic crisis, plasmapheresis Anaesthesiology Intensive Therapy 2013, vol. 45, no 2, 82-84 Myasthenia gravis (MG) is an autoimmune disease in which neuromuscular transmission is impaired due to a partial blocking of acetylcholine receptors in the postsynaptic membrane by circulating antibodies. Clinically, MG manifests as an abnormal fatigability of skeletal muscles that is relieved by rest and anticholinesterase drugs [1]. Its incidence rate is approximately 50-125: 1 000 000. The two major groups of patients include women aged 20-35 years and men aged 60-75 years. Children < 16 years of age constitute approximately 10-16% of all patients. Moreover, the prevalence of MG is three-fold higher in girls than in boys [1].When this disease progresses rapidly or the dosage of anticholinesterase drugs is too low and the susceptibility to them is consequently reduced, MG can progress to a life--threatening condition known as myasthenic crisis. CASE REPORTA 15-year-old boy (with a weight of 70 kg and a height of 165 cm) was admitted to the ICU of the Children's University Hospital from the neurology ward due to progressive hypodynamic respiratory failure and bulbar symptoms. His history revealed myasthenia of the lower limbs and articulation disorders that had been detected a year earlier. Based on clinical examinations, the patient was diagnosed with MG, and treatment with pyridostigmine at a dose of 60 mg day -1 was initiated. Moreover, a diagnosis of hypothyroidism was made, and levothyroxine was started 1 × 50 μg day -1 (euthyreosis for 3 months). The patient had a history of infantile cerebral ...

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Postępowanie u dziecka w przełomie miastenicznym

Rybojad¹,

Lesiuk²,

Fijałkowska-Nestorowicz³

et al. 2013

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…It took more than a decade until the first controlled trial was published, comparing IVIg and PE in patients with myasthenic crisis [Gajdos et al 1997]. The effectiveness has been confirmed by another controlled trial comparing IVIg with placebo in patients with worsening weakness due to myasthenia gravis [Zinman et al 2007].…”

Section: Myasthenia Gravismentioning

confidence: 98%

Review: New advances in the treatment of neurological diseases using high dose intravenous immunoglobulins

Stangel

2008

Ther Adv Neurol Disord

View full text Add to dashboard Cite

Since the incidental discovery in 1981 that intravenous immunoglobulins (IVIg) are immunomodulatory, they have been investigated in a large number of putative autoimmune diseases. This has led to licensing for idiopathic thrombocytopenic purpura, Kawasaki disease, and in neurological disorders for Guillain-Barré syndrome (GBS). Although not licensed, randomized controlled trials have also shown IVIg efficacy in other neuroimmunological diseases such as multifocal motor neuropathy (MMN), chronic inflammatory demyelinating neuropathy (CIDP), myasthenia gravis, dermatomyositis, and stiff-person syndrome. However, other indications are currently being explored including Alzheimer's disease, postpolio syndrome, and narcolepsy. There are even reports from experimental studies in stroke. The results of recently published clinical trials in both the classical neuroimmunological disorders as well as for new indications are reported and their role in clinical practice is discussed.

show abstract

“…The Osserman and MGFA classification system are based on the general impression of physicians on involvement and severity. Hence, using them as the hallmark of severity is a vicious circle; (II) composite ordinal scales such as Quantitative Myasthenia Gravis score (QMGs) (36), Myasthenia Gravis Composite (MGC) (37), Myasthenic Muscle Scale (MMS) (38), which are commonly used in Western countries, and the Absolute and Relative Score of MG (ARS-MG) (39), a commonly used scale in China. In 60 representative MG patients, all four scales were found to have good internal consistency, test-retest reliability, interobserver reliability, and construct validity.…”

Section: Relative Precision In the Main Domains Of Myasthenia Gravis mentioning

confidence: 99%

Precision medicine in myasthenia graves: begin from the data precision

Hong

Xie

et al. 2016

Ann. Transl. Med.

View full text Add to dashboard Cite

Myasthenia gravis (MG) is a prototypic autoimmune disease with overt clinical and immunological heterogeneity. The data of MG is far from individually precise now, partially due to the rarity and heterogeneity of this disease. In this review, we provide the basic insights of MG data precision, including onset age, presenting symptoms, generalization, thymus status, pathogenic autoantibodies, muscle involvement, severity and response to treatment based on references and our previous studies. Subgroups and quantitative traits of MG are discussed in the sense of data precision. The role of disease registries and scientific bases of precise analysis are also discussed to ensure better collection and analysis of MG data.

show abstract

Clinical trial of plasma exchange and high‐dose intravenous immunoglobulin in myasthenia gravis

Cited by 487 publications

References 20 publications

Postępowanie u dziecka w przełomie miastenicznym

Postępowanie u dziecka w przełomie miastenicznym

Review: New advances in the treatment of neurological diseases using high dose intravenous immunoglobulins

Precision medicine in myasthenia graves: begin from the data precision

Contact Info

Product

Resources

About