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Abstract Details

Management of Myasthenia Gravis Around the Globe: Consensus Guidelines vs. Realities of Practice
Neuromuscular and Clinical Neurophysiology (EMG)
P10 - Poster Session 10 (11:45 AM-12:45 PM)
11-018
To explore practices surrounding MG management across the globe with regard to alignment with the 2016 and 2020 international consensus guidelines.
There is great heterogeneity in the underlying pathophysiology of myasthenia gravis (MG), its clinical presentation, and response to treatment. International consensus guidelines were developed in 2016 and 2020 in an effort to standardize the approach to management of MG, however there remains uncertainty as to whether these efforts have been successful.
We administered an online, cross-sectional, case-based survey regarding MG management via Neurology’s: Practice Current section between 2020-2021 to neurologists and advanced practitioners. Analysis was purely descriptive. Responses were compared with recommendations outlined in the MG 2016 and 2020 consensus guidelines.

318 practitioners across 6 continents responded to the survey. Areas of discordance among respondents included the role of thymectomy, management of treatment-related side effects, management of acetylcholine receptor (AChR) antibody-negative MG, and management in preconception and pregnancy. Despite guidelines, only 54% of respondents recommended thymectomy in someone with AChR-MG, only 25% recommended vaginal delivery in someone with well controlled MG, and only 27% recommended early initiation of rituximab in someone with muscle-specific tyrosine kinase (MuSK) antibody-positive MG. Some of the areas of discordance observed were linked to regional differences in availability of therapies. For instance, 25% of respondents who did not recommended thymectomy indicated that thymectomy was not available to them in their current practice environment.
Our preliminary survey data suggests that despite efforts to create a set of international consensus guidelines, uncertainty persists in the neurology community surrounding MG management. We identify areas of agreement and disagreement that can help clinicians refine their own practice patterns and define the need for modified guidelines that highlight the side effect profiles, cost, and availability of therapies worldwide.
Authors/Disclosures
Julia Greenberg, MD
PRESENTER 		Dr. Greenberg has a non-compensated relationship as a Editorial Board Member with Neurology Resident and Fellow Section that is relevant to AAN interests or activities.
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary) Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli-Lilly. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生 (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has or had stock in SnapDx.Dr. Ganesh has or had stock in Collavidence Inc.Dr. Ganesh has or had stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.
Kiril Kiprovski, MD (NYU-Langone Health) Dr. Kiprovski has nothing to disclose.
Sujata P. Thawani, MD (NYU Neurology Associates) Dr. Thawani has nothing to disclose.