National guidelines for diagnosis, treatment, and management of myasthenia gravis in Israel

• Published in: Therapeutic advances in neurological disorders Vol. 18; p. 17562864251361607
• Main Authors: Shelly, Shahar, Gotkine, Marc, Wilf Yarkoni, Adi, Lotan, Itay, Abraham, Alon, Dori, Amir, Wolfe, Gil I., Regev, Keren, Vaknin, Adi, Ben-Hur, Tamir
• Format: Journal Article
• Language: English
• Published: England SAGE Publications 01.01.2025; SAGE Publishing
• Subjects: Review; MuSK antibodies; AChR antibodies; autoimmune; neuromuscular junction; myasthenia gravis; treatment guidelines; Israel; LRP4 antibodies
• ISSN: 1756-2864; 1756-2856; 1756-2864
• DOI: 10.1177/17562864251361607

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized primarily by fluctuating skeletal muscle weakness affecting ocular, bulbar, truncal, limb, and respiratory muscles. The disease is typically mediated by anti-acetylcholine receptor (AChR) antibodies, and less commonly by anti-muscle-specific kinase) or anti-low-density lipoprotein receptor-related protein 4 antibodies. Despite significant advancements in diagnostics and immunotherapy, disparities in treatment access and practice variability remain prevalent in Israel. To address these gaps, updated national guidelines have been developed, integrating the latest international evidence and adapting it to the local healthcare landscape, regulation, and population diversity. This national guideline emphasizes precise diagnostic evaluation through comprehensive clinical assessment, standardized antibody testing, neurophysiological studies, and mediastinal imaging for thymic pathology assessment. Utilizing standardized scales, including MG activities of daily living, quantitative MG score, and MG Foundation of America post-intervention status, is crucial for disease staging and therapeutic decision-making. Therapeutic goals prioritize achieving full remission or a state of minimal manifestations of disease with negligible treatment-related side effects. Guidelines for treatment strategies are based on antibody status, disease severity, patient age, and comorbidities. Thymectomy is recommended for patients with generalized AChR antibody-positive MG, ideally within 2 years of disease onset. Pregnant women, older adults, children, and patients with cancer need specific immunotherapy approaches. Multidisciplinary care, structured patient education, and psychosocial support are integral to managing MG effectively. These national guidelines aim to standardize clinical practices, enhance patient outcomes, and reduce healthcare disparities in the management of MG across Israel. National guidelines for management of myasthenia gravis in Israel Myasthenia gravis (MG) is a chronic disease where the body’s immune system mistakenly attacks the proteins on muscles, eventually causing weakness effecing the eyes, face, arms, legs, and breathing. Occuring most often due to auto-antibodies against a molecule called the acetylcholine receptor (AChR). Although medical care for MG has improved a lot, people in Israel still face differences in how the disease is diagnosed and treated. Best of our county experts created updated national guidelines. These new guidelines combine the latest global research with the realities of healthcare in Israel. They recommend using clear steps for diagnosis, including physical exams, blood tests for antibodies, nerve tests, and chest imaging to look for problems with the thymus gland. Doctors are encouraged to use scoring systems, like the MG-ADL and QMGS, to track how patients are doing and guide treatment decisions. The main goal is to help patients reach full recovery or to have very few symptoms, with as few side effects from treatment as possible. Treatment plans are based on things like which antibodies a patient has, how severe the disease is, age, and other health conditions. Surgery to remove the thymus is suggested for certain patients, especially early in the disease. Special care plans are needed for pregnant women, children, older adults, and people with cancer. The guidelines also stress the importance of teamwork among different health specialists, teaching patients about their disease, and providing emotional support. Overall, these national guidelines are meant to ensure that all MG patients in Israel get better, more equal care.