WED 238 Do we follow the abn myaesthenia guidelines?

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The ABN treatment guidelines1 for myasthenia Gravis (MG) have recently been published.


We reviewed the records of patients with MG to assess how well the ABN guidelines are being followed in a district general hospital based neurology centre.


All patients who had positive anti-AchR antibody tests from 2014–2017 and clinicians were asked to identify further patients. Retrospective review of electronic patient record, clinic letters and laboratory data reviewed.


59 patients; 24 ocular and 35 generalised (by type - II: 17, III:15, IV:1, V:1, unclear:1). 63% male, average age 64 (range 18–91). 22/35 (62.8%) generalised MG patients were in remission off pyridostigmine. 13 on steroids, 17 azathioprine, 5 mycophenolate; 3 methotrexate. 2 patients were admitted to ITU, 16 patients had inpatient admissions, 11 patients had IVIG.


14/24 (58.3%) with ocular MG were in remission off pyridostigmine; 5 on steroids, 6 azathioprine. 2 patients had been admitted. 7 of 23 patients on AZT (30.4%) did not have a TMPT level recorded, with only 19 (79%) having sufficiently regular bloods monitoring.


Treatment for most patients followed the ABN guidelines. The most common difficulties related to testing for TMPT and blood monitoring.


1. Sussman J, Farrugia ME, Maddison P, et al. Myasthenia gravis: Association of British neurologists’ management guidelines. Practical Neurology2015;15:199–206.

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