International consensus guidance for management of myasthenia gravis: Executive summary

被引:728
作者
Sanders, Donald B. [1 ]
Wolfe, Gil I. [2 ]
Benatar, Michael [3 ]
Evoli, Amelia [4 ]
Gilhus, Nils E. [5 ]
Illa, Isabel [6 ,7 ]
Kuntz, Nancy [8 ,9 ]
Massey, Janice M. [1 ]
Melms, Arthur [10 ,11 ]
Murai, Hiroyuki [12 ]
Nicolle, Michael [13 ]
Palace, Jacqueline [14 ]
Richman, David P. [15 ]
Verschuuren, Jan [16 ]
Narayanaswami, Pushpa [17 ]
机构
[1] Duke Univ, Med Ctr, Dept Neurol, Durham, NC 27708 USA
[2] SUNY Buffalo, Sch Med & Biomed Sci, Dept Neurol, Buffalo, NY 14260 USA
[3] Univ Miami, Miller Sch Med, Dept Neurol, Coral Gables, FL 33124 USA
[4] Catholic Univ, Dept Neurol, Rome, Italy
[5] Univ Bergen, Dept Clin Med, N-5020 Bergen, Norway
[6] Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Neurol, Barcelona, Spain
[7] CIBERER U762, Barcelona, Spain
[8] Northwestern Feinberg Sch Med, Dept Pediat, Chicago, IL USA
[9] Northwestern Feinberg Sch Med, Dept Neurol, Chicago, IL USA
[10] Univ Klinikum Erlangen, Neurol Klin, Erlangen, Germany
[11] Univ Tubingen, Inst Clin Res, Tubingen, Germany
[12] Kyushu Univ, Grad Sch ofMed Sci, Dept Neurol Therapeut, Fukuoka, Japan
[13] Univ Western Ontario, Dept Clin Neurol Sci, London, ON, Canada
[14] Oxford Univ Hosp Trust, John Radcliffe Hosp, Dept Clin Neurol, Oxford, England
[15] Univ Calif Davis, Dept Neurol, Davis, CA 95616 USA
[16] Leiden Univ, Med Ctr, Dept Neurol, Leiden, Netherlands
[17] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA USA
关键词
GUIDELINES;
D O I
10.1212/WNL.0000000000002790
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective:To develop formal consensus-based guidance for the management of myasthenia gravis (MG).Methods:In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness methodology was used to develop consensus guidance statements. Definitions were developed for goals of treatment, minimal manifestations, remission, ocular MG, impending crisis, crisis, and refractory MG. An in-person panel meeting then determined 7 treatment topics to be addressed. Initial guidance statements were developed from literature summaries. Three rounds of anonymous e-mail votes were used to attain consensus on guidance statements modified on the basis of panel input.Results:Guidance statements were developed for symptomatic and immunosuppressive treatments, IV immunoglobulin and plasma exchange, management of impending and manifest myasthenic crisis, thymectomy, juvenile MG, MG associated with antibodies to muscle-specific tyrosine kinase, and MG in pregnancy.Conclusion:This is an international formal consensus of MG experts intended to be a guide for clinicians caring for patients with MG worldwide.
引用
收藏
页码:419 / 425
页数:7
相关论文
共 11 条
  • [1] Deenen Johanna C W, 2015, J Neuromuscul Dis, V2, P73
  • [2] Fitch KBSJ., 2001, The RAND/UCLA appropriateness method user's manual. RAND
  • [3] Fuhr P., 2012, LEITLINIEN DIAGNOSTI, P830
  • [4] Lifetime course of myasthenia gravis
    Grob, David
    Brunner, Norman
    Namba, Tatsuji
    Pagala, Murali
    [J]. MUSCLE & NERVE, 2008, 37 (02) : 141 - 149
  • [5] Myasthenia gravis - Recommendations for clinical research standards
    Jaretzki, A
    Barohn, RJ
    Ernstoff, RM
    Kaminski, HJ
    Keesey, JC
    Penn, AS
    Sanders, DB
    [J]. NEUROLOGY, 2000, 55 (01) : 16 - 23
  • [6] Murai H., 2015, Clin Exp Neuroimmunol, V6, P21, DOI [10.1111/cen3.12180, DOI 10.1111/CEN3.12180]
  • [7] Myasthenia in pregnancy: best practice guidelines from a UK multispecialty working group
    Norwood, Fiona
    Dhanjal, Mandish
    Hill, Marguerite
    James, Natalie
    Jungbluth, Heinz
    Kyle, Pippa
    O'Sullivan, Geraldine
    Palace, Jacqueline
    Robb, Stephanie
    Williamson, Catherine
    Hilton-Jones, David
    Nelson-Piercy, Catherine
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2014, 85 (05) : 538 - 543
  • [8] Guidelines for treatment of autoimmune neuromuscular transmission disorders
    Skeie, G. O.
    Apostolski, S.
    Evoli, A.
    Gilhus, N. E.
    Illa, I.
    Harms, L.
    Hilton-Jones, D.
    Melms, A.
    Verschuuren, J.
    Horge, H. W.
    [J]. EUROPEAN JOURNAL OF NEUROLOGY, 2010, 17 (07) : 893 - 902
  • [9] Sussman Jon, 2015, Pract Neurol, V15, P199, DOI 10.1136/practneurol-2015-001126
  • [10] U.S. Department of Health and Human Services NIH National Cancer Institute, COMM TERM CRIT ADV E