Treatment of myasthenia gravis: current practice and future directions

References

• Phillips LH, Tomer JC. Epidemiologic evidence for a changing natural history of myasthenia gravis. Neurology 47(5), 1233–1238 (1996).
   PubMed Web of Science ®Google Scholar
• Osserman KE, Genkins E. Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. Mt Sinai Merl 38, 497–453 (1971).
   PubMed Web of Science ®Google Scholar
• Golnik KC, Pena R, Lee AG, Eggenberger ER. An ice test for the diagnosis of myasthenia gravis. Ophthalmology 106, 1282–1286 (1999).
   PubMed Web of Science ®Google Scholar
• Sanders DB, Andrews PI, Howard JF, Massey JM. Seronegative myasthenia gravis. Neurology 48\(Suppl. 5), S40—S51 (1997).
   Google Scholar
• Hock W McConville J, Helms S, Newsom- Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat. Merl 7(3), 365–368 (2001).
   Google Scholar
• Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology 55 (1), 7–15 (2000).
   PubMed Web of Science ®Google Scholar
• ••Systemic review of the controlled, but notrandomized studies describing outcomes in MG patients undergoing and not undergoing thymectomy. It concludes that thymectomy is recommended as an option to increase the probability of remission or improvement in patients with nonthymomatous autoimmune MG, based on Class 11 evidence.
   Google Scholar
• Shumm F, Wietholter H, Fateh-Moghadam A. Thymectomy in myasthenia with pure ocular symptoms. J. Neural Neumsurg. Psychiatry 48, 332–337 (1985).
   PubMedGoogle Scholar
• Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America; Jaretzki A, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS, Sanders DB. Myasthenia gravis: recommendations for clinical research standards. Neumlogy55(1), 16–23 (2000).
   PubMedGoogle Scholar
• ••Guidelines developed by a Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America include a revised Clinical Classification, a MGFA Therapy Status, MGFA Postintervention Status, Thymectomy classification and recommendations to develop clinical outcome measures specific for MG.
   Google Scholar
• Pascuzzi RM, Coslett HB, Johns TR. Long- term corticosteroid treatment of myasthenia gravis: report of 116 patients. Ann. Neural 15, 291–298 (1984).
   Google Scholar
• Rivner MET. Steroid treatment for myasthenia gravis. Steroids are overutilized. Muscle Nerve 25(1), 115–117 (2001).
   Google Scholar
• Bedlack RS, Sanders DB. Steroid treatment for myasthenia gravis. Steroids have an important role. Muscle Nerve 25(1), 117–121 (2001).
   Google Scholar
• Bromberg MB, Wald JJ, Forshew DA, Feldman EL, Albers JW Randomized trial of azathioprine or prednisone for initial immunosuppressive treatment of myasthenia gravis. New& Sci. 150, 59–62 (1997).
   Google Scholar
• Palace J, Newsom-Davis J, Lecky B and the Myasthenia Gravis Study Group. A randomized double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis. Neurology50(6), 1778–1783 (1998).
   PubMed Web of Science ®Google Scholar
• Tindall R, Rollins J, Phillips J et al. Preliminary results of a double-blind, randomized, placebo-controlled trial of cyclosporin in myasthenia gravis. N Engl Med. 316, 719–724 (1987). 12-month, double-blind, randomized,placebo-controlled trial of cyclosporin in 20 MG patients. At 6 months, patients in the cyclosporin group had had significantly more objective improvement in strength than the ones in the placebo group. The improvement continued to be greater at 12 months. Nephrotoxicity occurred in three patients receiving cyclosporin.
   Google Scholar
• Ciafaloni E, Nikhar N, Massey JM, Sanders DB. Retrospective analysis of the use of cyclosporin in myasthenia gravis. Neurology 55, 448–450 (2000).
   PubMed Web of Science ®Google Scholar
• •Retrospective analysis of the use of cyclosporin in 57 MG patients taking this drug for an average of 3.5 years and showed clinical improvement in 96%. Side effects included malignancy in 11% and elevation of serum creatinine in 28% of the patients.
   Google Scholar
• Hojo M, Morimoto T, Maluccio M et al. Cyclosporin induces cancer progression by a cell-autonomous mechanism. Nature 397, 530–534 (1999).
   PubMed Web of Science ®Google Scholar
• Allison AC, Eugui EM. Purine metabolism and immunosuppressive effects of Mycophenolate mofetil (MMF). Gun. 71ansplant. 10, 77–84 (1996).
   Google Scholar
• Ciafaloni E, Massey JM, Tucker-Lipscomb B, Sanders DB. Mycophenolate mofetil for myasthenia gravis: an open-label pilot trial. Neurology56(1), 97–99 (2000).
   Google Scholar
• ••An open-label trial of MIVI, in whichimprovement was demonstrated in eight out of 12 patients who had refractory MG, or who were taking only corticosteroids and required additional imrnunosuppression. No major side effects were observed.
   Google Scholar
• Hauser RA, Malek AR, Rosen R. Successful treatment of a patient with severe refractory myasthenia gravis using mycophenolate mofetil. Neurology51 (3), 912–913 (1998).
   PubMedGoogle Scholar
• Meriggioli MN, Rowin J. Treatment of myasthenia gravis with mycophenolate mofetil: a case report. Muscle Nerve 23(8), 1287–1289 (2000).
   PubMedGoogle Scholar
• Chaudhry V, Comblath DR, Griffin JW, O'Brien R, Drachman DB. Mycophenolate mofetil: a safe and promising immunosuppressant in neuromuscular diseases. Neurology56(1), 94–96 (2000).
   Google Scholar
• Yeh JH, Chu HC. Plasmapheresis in myasthenia gravis. A comparative study of daily versus alternate daily schedule. Acta Neural. Scand. 99, 147–151 (1999).
   Google Scholar
• Dwyer JM. Manipulating the immune system with immune globulin. N Engl. J. Med. 326, 107–116 (1992).
   PubMed Web of Science ®Google Scholar
• Howard JE Intravenous immunoglobulin for the treatment of myasthenia gravis. Neurology51, S 30–37 (1998).
   Google Scholar
• •The consensus of an expert panel is that MG is effective in reversing myasthenic weakness and appears to have a role as an acute treatment intervention in rapidly progressive weakness, or as a chronic maintenance therapy when all other treatment modalities have failed.
   Google Scholar
• Gajdos P, Chevret S, Clair B, Tranchant C, Chastang C. Clinical trial of plasma exchange and high-dose iv. immunoglobulin in myasthenia gravis. Ann. Neural 41, 789–796 (1997).
   Google Scholar
• Araga S, Xu L, Nakashima K, Villain M, Blalock JE. A peptide vaccine that prevents experimental autoimmune myasthenia gravis by specifically blocking T-cell help. FASEBJ 14, 185–196 (2000).
   Google Scholar
• •• A single monoclonal antibody against a complementary peptide for the dominant T-cell epitope on the AChR lessened the incidence and severity of EAMG.
   Google Scholar
• Xu L, Villain M, Galin FS, Araga S, Blalock E. Prevention and reversal of experimental autoimmune myasthenia gravis by a monoclonal antibody against acetylcholine receptor-specific T-cells. Cell. Immunal 208, 107–114 (2001).
   Google Scholar