Self-Assessment: Immune Mediated Peripheral Neuropathies | Paradigm Clashes: Debate & Exploration in Choosing Traditional vs Novel Immunotherapeutics for MG-Paradigm Clashes: Dr. Li Presentation

Paradigm Clashes: Dr. Li Presentation

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The document outlines a medical case discussion led by Yuebing Li, M.D., Ph.D., at the Cleveland Clinic's Neuromuscular Center, presenting several clinical cases related to generalized myasthenia gravis (MG), focusing on treatment approaches and patient outcomes. Dr. Li has financial ties with several pharmaceutical companies and discusses off-label treatments.<br /><br />**Case Summaries:**<br /><br />1. **Case #1:**<br />   An 86-year-old female with MG showed improvement on pyridostigmine but required additional treatments. Prednisone and FcRn therapy reduced the MG-ADL score significantly without side effects. Early aggressive therapy is suggested to result in rapid improvement.<br /><br />2. **Case #2:**<br />   A 35-year-old female achieved remission through robotic thymectomy. Long-term low-dose prednisone maintained remission, indicating thymectomy’s effectiveness in young females with MG.<br /><br />3. **Case #3:**<br />   A 42-year-old female with refractory MG experienced symptom fluctuations managed by adjusting the frequency of FcRn therapy. This adjustment stabilized her condition, showing the importance of customizing treatment schedules.<br /><br />4. **Case #4:**<br />   A 64-year-old male no longer responded to traditional MG treatments but improved with complement inhibition. This therapy was eventually stopped without relapse. The case stressed the non-necessity of indefinite immunotherapy.<br /><br />5. **Case #5:**<br />   A 52-year-old male previously improved with PLEX and faced an antibody rebound, a phenomenon seen post-FcRn therapy due to increased antibody synthesis and redistribution.<br /><br />6. **Case #6:**<br />   A 66-year-old male benefited significantly from infrequent IVIG therapy, challenging the viewpoint that IVIG lacks maintenance efficacy in MG, suggesting its continued use.<br /><br />The document emphasizes tailored treatment plans, the potential for long-term remission, and the consideration of infection risks with complement inhibitors. Vaccinations for patients on these therapies are advised to prevent infections like Neisseria. Finally, the document encourages feedback via the AANEM app and outlines how to claim session credits.

Keywords

generalized myasthenia gravis

treatment approaches

patient outcomes

Yuebing Li

off-label treatments

FcRn therapy

thymectomy

complement inhibition

IVIG therapy

infection risks