scholarly journals Immunoglobulin versus Plasmapheresis in treatment of Myasthenia Gravis: a systematic review

2021 ◽  
Author(s):  
Isabella Delfim de Carvalho ◽  
Felipe Iankelevich Baracat ◽  
Lucas Farina Lima
Keyword(s):  
Systematic Review ◽  
Myasthenia Gravis ◽  
Therapeutic Option ◽  
Length Of Hospital Stay ◽  
Treatment Phase ◽  
Ivig Therapy ◽  
Myasthenic Crisis ◽  
Double Filtration Plasmapheresis ◽  
Double Filtration ◽  
Result Analysis

Introduction: Myasthenia Gravis (MG) is an autoimmune and neuromuscular disease. The treatment of immunomodulation consists of intravenous immunoglobulin (IVIg), immunoadsorption (IA), plasmapheresis (PLEX) or double filtration plasmapheresis (DFPP). This systematic review aims to compare therapy modalities in MG crisis. Methods: The studies were identified through research in electronic databases and analyzed individually to clarify their methodological quality (through the Jadad and Newcastle Ottawa scale). Clinical trials randomized or not, and retrospective studies were included. The review included 1,983 patients in nine studies, the result analysis groups were divided into: IVIg x PLEX in the crises; IVIg x PLEX in the pre-thymectomy treatment phase and IVIg x DFPP in the myasthenic crisis. The evaluated outcomes were clinical improvement, adverse effects and length of hospital stay. Results: Immunomodulatory therapy when applied prior to thymectomy was shown to be effective in reducing symptoms and post-thymectomy hospitalization, with IVIg slightly higher, while PLEX showed more side effects. Therapy during crises in both interventions proved to be effective after the 14th start of treatment, in addition to IVIg being slightly superior. Treatment with IVIg was also economically favorable, due to the lower need for hospitalizations. IVIg proved to be inferior to therapy with DFPP and IA, mainly in reducing the need for hospitalization. Conclusion: It is concluded that IVIg therapy is a good therapeutic option in cases of crisis and when available, therapies with DFPP and IA should be the choices, aiming at less complications.

Double filtration plasmapheresis benefits myasthenia gravis patients through an immunomodulatory action

2014 ◽  
Vol 21 (9) ◽  
pp. 1570-1574 ◽  
Author(s):  
Lei Zhang ◽  
Junfeng Liu ◽  
Hongna Wang ◽  
Chongbo Zhao ◽  
Jiahong Lu ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Double Filtration Plasmapheresis ◽  
Immunomodulatory Action ◽  
Double Filtration

scholarly journals Latissimus dorsi detrusor myoplasty for bladder acontractility: a systematic review

2021 ◽  
Vol 48 (5) ◽  
pp. 528-533
Author(s):  
Antonio Jorge Forte ◽  
Daniel Boczar ◽  
Maria Tereza Huayllani ◽  
Steven Moran ◽  
Oluwaferanmi O. Okanlami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Latissimus Dorsi ◽  
Therapeutic Option ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Clean Intermittent Catheterization ◽  
Cochrane Central Register ◽  
Eligibility Criteria ◽  
Cord Injury

Bladder acontractility affects several thousand patients in the United States, but the available therapies are limited. Latissimus dorsi detrusor myoplasty (LDDM) is a therapeutic option that allows patients with bladder acontractility to void voluntarily. Our goal was to conduct a systematic review of the literature to determine whether LDDM is a better option than clean intermittent catheterization (CIC) (standard treatment) in patients with bladder acontractility. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases, without time frame limitations, to identify articles on the use of LDDM for bladder acontractility. Of 75 potential articles, 4 fulfilled the eligibility criteria. The use of LDDM to treat patients with bladder acontractility was reported in four case series by the same group in Europe. Fifty-eight patients were included, and no comparison groups were included. The most common cause of bladder acontractility was spinal cord injury (n=36). The mean (±standard deviation) operative time was 536 (±22) minutes, postoperative length of hospital stay ranged from 10 to 13 days, and follow-up ranged from 9 to 68 months. Most patients had complete response, were able to void voluntarily, and had post-void residual volume less than 100 mL. Although promising outcomes have been obtained, evidence is still weak regarding whether LDDM is better than CIC to avoid impairment of the urinary tract among patients with bladder acontractility. Further prospective studies with control groups are necessary.

scholarly journals Takotsubo syndrome in patients with myasthenia gravis: a systematic review of previously reported cases

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Devarajan Rathish ◽  
Minuri Karalliyadda
Keyword(s):  
Systematic Review ◽  
Myasthenia Gravis ◽  
Case Reports ◽  
Rare Condition ◽  
Myasthenic Crisis ◽  
Takotsubo Syndrome ◽  
Clinical Presentations ◽  
Life Threatening ◽  
Care Guidelines ◽  
The Common

Abstract Background Myasthenia gravis associated takotsubo syndrome is a rare condition. This study aimed to explore its typical presentation, investigations and treatment through a systematic review of previously reported cases. Methods Databases and reference lists of the selected articles were searched for case reports on Myasthenia gravis associated takotsubo syndrome. CARE guidelines were used for the quality assessment of the selected articles. Results Sixteen cases were selected out of 580 search results. Western Pacific, American and European regions contributed to 88% of the cases. Females were most affected (81%). Features of both myasthenia gravis and takotsubo syndrome were the common clinical presentations. All cases had a myasthenic crisis. Half of the cases had no prior diagnosis of myasthenia gravis. Pyridostigmine and prednisolone were useful for myasthenia gravis while dobutamine was most commonly used for takotsubo syndrome. All cases survived except four (25%). Conclusions Myasthenia gravis associated takotsubo syndrome via a myasthenic crisis is rare but life-threatening. Therefore, predisposition due to emotional and physical triggers needs to be avoided for its prevention. The rare entity should be suspected even in patients without a prior diagnosis of Myasthenia gravis.

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