2025 American Academy of Neurology Abstract Website

Objective:

We undertook a retrospective analysis of patients admitted to a 700 bed teaching hospital between July 2020 and January 2024 with an aim of evaluating utilization of intravenous immunoglobulin (IVIG) for myasthenic crisis (MC), percentage of patients treated with IVIG who required escalation of care to plasma exchange (PLEX),patient characteristics to help guide initial management selection for patients in MC and the impact of initial treatment choice on clinical outcomes.

Background:

The choice between IVIG and PLEX for treatment of MC depends on individual patient factors and provider preference. Expert consensus suggests PLEX is more effective and rapid. Current literature suggests functional outcomes may be similar long-term. If improvement is not seen with one intervention, providers may switch to the other.

Design/Methods:

Retrospective chart review unique encounters for hospitalized adult patients who received IVIG or PLEX for MG with acute exacerbation from July 1, 2020, to January 31, 2024. Inclusion criteria were adults >18 years with a diagnosis code of MG with acute exacerbation, who received IVIG or PLEX and required non-invasive ventilation or intubation.

Results:

62% encounters used IVIG as initial treatment with a success rate of 64.5% (no escalation to PLEX and/or readmission within 30 days for MC). In the unsuccessful encounters,10% discontinued treatment early due to an adverse events or treatment failure, 16.5% received IVIG followed by PLEX during same encounter and 23% were re-admitted for MC within 30 days. One patient died due to cardiogenic shock. Patient characteristics associated with unsuccessful IVIG treatment included thymoma, previous thymectomy, previous crisis and established outpatient pyridostigmine use.

Conclusions:

: Larger studies evaluating physical exam features and activities of daily living are needed to help clinicians decide the choice of management in MC to improve outcomes.