Plasmapheresis or intravenous immunoglobulin for myasthenia gravis crisis in King Chulalongkorn Memorial Hospital.

ABSTRACT

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. MATERIAL AND METHOD: 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. CONCLUSION: 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.