Practice advisory: Thymectomy for myasthenia gravis (practice parameter update) Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

Objective To review updated evidence regarding the effectiveness of thymectomy for treating patients with myasthenia gravis (MG). Methods The practice advisory panel performed a systematic review and developed practice recommendations using methods developed by the American Academy of Neurology. Results One Class I study of patients younger than 65 years with nonthymomatous acetylcholine receptor antibody-positive (AChR ab+) generalized MG demonstrated better clinical outcomes in patients treated with oral prednisone and undergoing thymectomy compared with patients treated with prednisone alone, including an increased probability of attaining minimal manifestation status (no symptoms or functional limitations). Conclusion For patients with nonthymomatous AChR ab+ generalized MG, treatment with thymectomy plus prednisone is probably more effective than treatment with prednisone alone for increasing the chance of attaining minimal manifestation status (risk difference at 36 months, 20%; 95% confidence interval, 1.6%-37%; moderate confidence in the evidence). Recommendations Clinicians should discuss thymectomy treatment with patients with AChR ab+ generalized MG (Level B). Clinicians should counsel patients with AChR ab+ generalized MG considering minimally invasive thymectomy techniques that it is uncertain whether the benefit attained by extended transsternal thymectomy will also be attained by minimally invasive approaches (Level B).