Sundulagunta et al listed findings that can help to identify a patient with refractory myasthenia gravis. The authors are from Columbia Asia Hospital, Baptist Hospital, K.S. Hegde Medical College and Dr B.R. Ambedkar Medical College in Bangalore, India.
Refractory myasthenia refers to a failure to respond to standard therapy.
Clinical findings in refractory myasthenia gravis may include:
(1) Poor or no control of myasthenia on optimized immunosuppression.
(2) An inability to reduce immunotherapy without clinical relapse.
Sudulagunta et al also included the presence of severe complications of immunosuppressive therapy for > 12 months, although this might be questioned as being indicative of refractoriness.
The diagnosis also requires
(1) exclusion of other conditions that may exacerbate or mimic myasthenia.
(2) exclusion of noncompliance
(3) exclusion of error in dosing or medications
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