Myasthenia Gravis Autoimmune – consensus guideline

This guideline was developed through the Neuromuscular Diseases working group (Spierziekten Centrum Nederland) of the Dutch Society of Neurology. The foundation for this guideline was the international guideline (Neurology 2016;87:419), recent reviews, and existing protocols from various university medical centers (UMCs). Based on these sources, an initial version was drafted by the neuromuscular group at LUMC. This version was distributed among the centers within Spierziekten Centrum Nederland and discussed at the Belgian-Dutch Neuromuscular Study Club on October 25, 2017. Following feedback from various contributors, the text was revised, and a new version was created. This revised version was again distributed among the neuromuscular centers within Spierziekten Centrum Nederland and was ultimately approved in December 2018, with publication on the SCN website. Approximately one year after publication, in 2020, feedback was requested from the neuromuscular centers regarding its use in daily practice. Since then, several modifications have been made, and the guideline continues to be updated regularly.

Versions:

• Version 1.0 November 2017
• Version 1.1 May 2018
• Version 1.3 November 2018
• Version 1.4 December 2018
• Version 1.6 December 2018 – Published on SCN Website
• Version 1.7 June 2021 – Contributions from: AMC (Neuromuscular group), ErasmusMC (Neuromuscular group), MUMC+ (Janneke Hoeymakers, neurologist), LUMC (Umesh Badrising, neurologist; Martijn Tannemaat, neurologist; Jan Verschuuren, neurologist), VSN, Myasthenia Working Group (Johan Voerman).
• Version 1.8 September 2021 – Contributions from: LUMC NMZ Team (Umesh Badrising, Chiara Straathof, Martijn Tannemaat, Jan Verschuuren); Editor: Jan Verschuuren.
• Version 1.9 January 2022 – A section on neonatal myasthenia was added (contributions from Remco Visser and Erik Niks).

Guidelines contain recommendations intended for medical professionals. In individual cases, these recommendations may not be applicable. Certain facts or circumstances may arise that justify deviating from the guideline in the best interest of the patient. Any deviation from the guideline should be well-argued and documented in the medical record. The applicability and implementation of the guidelines in practice remain the responsibility of the treating physician.