Plasmapheresis or intravenous immunoglobulin for myasthenia gravis crisis in King Chulalongkorn Memorial Hospital.
BACKGROUND
Myasthenia gravis (MG) crisis is a life-threatening and unpredictable complication of MG Prognosis of MG crisis has dramatically improved due to modern immunomodulation. However the choice of plasmapheresis or intravenous immunoglobulin (IVIG) is still a controversial issue.


OBJECTIVE
Evaluate the efficacy and outcomes of MG crisis treatment with plasmapheresis or IVIG in King Chulalongkorn Memorial Hospital (KCMH) during the past 5 years.


METHODS
Episodes of MG crisis with respiratory failure were recruited retrospectively from database of KCMH between 2001 and 2006.


RESULTS
Thirty-three episodes of MG crisis with respiratory failure from 26 patients (9 males and 17 females) were documented. Plasmapheresis and IVIG were prescribed in 21 and 9 episodes of MG crisis, respectively. There was no statistical significant difference in baseline characteristics between both groups. The mean duration of intubation in plasmapheresis group was 12 +/- 11.1 days and in IVIG group was 10.3 +/- 4.6 days. The mean length of hospital stay (LOS) in plasmapheresis and IVIG were 30.7 +/- 29.6 days and 25.4 +/- 16.2 days, respectively. Hospital acquired pneumonia (HAP) occurred in four episodes (18.2%) in plasmapheresis and 1 episode (11.1%) in IVIG There was no statistical difference in the outcome of both treatment groups. All patients in both groups were well upon discharge.


CONCLUSIONS
MG crisis with respiratory failure was safely managed with either plasmapheresis or IVIG in KCMH. The present study cannot demonstrate any differences in the efficacy of plasmapheresis or IVIG. This may be due to inadequate sample size thus more patients should be recruited for further study.
Pittayanon
Rapat
R
Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand. Rapat125@gmail.com
Treeprasertsuk
Sombat
S
Phanthumchinda
Kammant
K
D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007163:Immunosorbent Techniques; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000628:therapy*; D010951:Plasma Exchange; D010956:Plasmapheresis / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors