Abstract Details

Title Extended Duration Plasmapharesis does not Improve Outcomes in Myasthenic Crisis

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-001

Objective To determine if more sessions (≥6) of plasmapheresis improved hospital length of stay or altered discharge disposition.

Background Plasmapheresis is a proven therapy for myasthenia crises. However, it is an invasive procedure with multiple known complications. A standard course of treatment often includes five exchange sessions, based, in part, on data suggesting 70% of antibody removal per body volume exchanged. However, neurologists may extend the number of exchanges based on clinical judgment alone.

Design/Methods We retrospectively reviewed 1473 patients admitted to a tertiary academic medical center from July 2008 to July 2017 with myasthenia gravis. We identified 48 patients who received plasmapheresis during their hospital course for myasthenic crisis. Groups were divided into patients who received ≤5 exchanges or ≥6 exchanges, based on the “standard of care” in the literature of five exchanges. We performed two-tailed t-test to determine if increased number of sessions of plasmapheresis improves our primary outcome, hospital length of stay, and a chi-squared test to analyze secondary outcome of disposition, home and skilled nursing facility vs long term acute care facility and death.

Results There was no statistically significant difference in age, gender, seropositivity, prednisone usage or steroid-sparing agent usage between the two groups. There was no observable nor statistically significant improvement in length of stay or disposition on discharge with additional sessions of plasmapheresis.

Conclusions This is the largest dataset of plasmapheresis-related myasthenic crises to our knowledge. There is no statistically significant difference in length of stay or overall mortality in patients who received greater than five exchanges compared to those who received five or fewer. A prospective study may be warranted.

Authors/Disclosures
Lee E. Neilson, MD PRESENTER	Dr. Neilson has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Hart Wagner LLP. Dr. Neilson has received research support from VA ORD - Clinical Science Research and Development. An immediate family member of Dr. Neilson has received research support from NIH - NINDS.
Michael Hansen, MD (UW Health)	No disclosure on file
	No disclosure on file
Bashar Katirji, MD, F�鶹��ýӳ�� (University Hospitals Cleveland Medical Ctr- Case Western Reserve University)	Dr. Katirji has nothing to disclose.

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