Diagnosis: Myasthenia gravis
Issue under review: IVIG

Determination:
The IVIG is not medically necessary.

The patient's neurological examination without intravenous immunoglobulin, was completely normal. Therefore, the patient is clinically stable and her symptoms are controlled with Mestinon. There is no documentation of ptosis, diplopia, abnormal swallowing or abnormal gait. FDA as well as peer-reviewed published medical literature do not support the use of intravenous immunoglobulin for maintenance of myasthenia. Additionally, there is no evidence in the published medical literature that intravenous immunoglobulin in myasthenia has any advantages comparing to cyclosporine or tacrolimus for disease maintenance. In the absence of such evidence, the proposed treatment is not medically necessary.