Quantitative myasthenia gravis score: assessment of responsiveness and longitudinal validity

A comparison of the effectiveness of intravenous immunoglobulin and plasma exchange as preoperative therapy of myasthenia gravis

OBJECTIVES

Immunomodulation with plasma exchange is effective in preparing patients for thymectomy. Newer forms of immunomodulation, such as intravenous immunomodulation, require evaluation in this clinical setting.

METHODS

We conducted a retrospective chart review to determine if plasma exchange and intravenous immunoglobulin had comparable effectiveness in the preoperative preparation of patients with myasthenia gravis.

RESULTS AND CONCLUSIONS

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.

Childhood myasthenia: clinical subtypes and practical management

In recent years, understanding of the pathogenesis and clinical presentation of distinct myasthenia subtypes has increased significantly. This article reviews the clinical manifestations of autoimmune myasthenia gravis (including myasthenia associated with anti-muscle-specific kinase antibodies), ocular myasthenia, and antibody negative myasthenia. The following treatments are examined: cholinesterase inhibitors, immunosuppressants, and thymectomy. Inherited congenital myasthenic syndromes (CMS) are now increasingly recognized, and most commonly present during childhood. This article outlines the presynaptic, synaptic basal lamina-associated, and postsynaptic classification of CMS and the clinical presentation and aetiology of individual syndromes. Relevant investigations and treatment options (including the role of pyridostigmine, 3,4-diaminopyridine, fluoxetine, and ephedrine) are discussed.