The Effect of Preoperative AchR-Ab Level to the Prognosis in Operated Myasthenia Gravis Patients (original) (raw)
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Revista de Chimie
Myasthenia gravis is an autoimmune disorder which presents a series of clinical manifestations which are generally motor. The hallmark of the disorder is muscle weakness, which typically worsens during physical exercise and improves upon rest. Approximatively 80% of the patients presenting this affection test positive for Acetylcholine antibody anti-receptor (AChR-ab).Treatment of patients with myasthenia gravis consists of:administration of oral medica-tion, immunomodulating treatment by removal of AChR-ab through plasmapheresis or surgical intervention (thymectomy).This article presents a retrospective study in which the authors attempted to identify factors which can influence the effect of thymectomy on AChR-ab titration and on the clinical presentation of the patients suffering with myasthenia gravis.
2006
Myasthenia Gravis hastal›¤›nda transsternal timektomi sonras› komplikasyonlar halen önemli bir sorundur. Bu çal›flmada, ameliyat öncesi medikasyonla komplikasyonlar aras›ndaki iliflkiyi ortaya koymak amaçland›. Çal›flma plan›: Transsternal timektomi yap›lan ve timo-mas› olmayan 229 Myasthenia Gravis hastas› (164 kad›n 65 erkek; ort. yafl 35.6; da¤›l›m 9-70) çal›flma grubunu oluflturdu. Ameliyat sonras› komplikasyonlar ile yafl, cinsiyet, semptomlar›n süresi, hastal›¤›n klinik evresi, cerrahi prosedür ve ameliyat öncesi medikasyon aras›nda iliflki araflt›r›ld›. Çal›flma grubu ameliyat öncesi medikasyonuna göre befl gruba ayr›ld›: Grup 1 (n=51) kolinesteraz inhibitörleri, grup 2 (n=30) kortikosteroidler, group 3 (n=125) kolinesteraz inhibitörleri ve kortikosteroidler, grup 4 (n=13) immünsüpressifler, kolinesteraz inhibitörleri ve kortikosteroidler, group 5 (n=10) medikasyon verilmeyen. Ameliyat sonras› komplikasyonlar ise i) enfeksiyon (n=18), ii) miyastenik komplikasyonlar (n=14) ve iii) di-¤er komplikasyonlar olarak tan›mland› (n=7). Bulgular: Komplikasyonlar ile analiz edilen di¤er de¤iflkenler aras›nda tedavi altgruplar› d›fl›nda anlaml› bir iliflki bulunamad›. Kolinesteraz inhibitörleriyle birlikte immünsüpressif tedavi ve kortikosteroid kulan›m›yla komplikasyon geliflimi aras›nda istatistiksel olarak anlaml› iliflki sap-tand› (p=0.004). Sonuç: Bulgular›m›z, Myasthenia Gravis hastal›¤›nda transsternal timektomi uygulanan hastalarda, kolinesteraz inhibitörüyle birlikte kortikosteroid ve immünsüpressif tedavi kullananlarda komplikasyon oran›n›n artabilece¤ini göstermektedir. Anahtar sözcükler: Myasthenia Gravis/cerrahi; timektomi/yöntem. Could preoperative medication in myasthenia gravis be a cause of the complications following transsternal thymectomy? Myasthenia Gravis'te ameliyat öncesi medikasyon, transsternal timektomi sonras› komplikasyonlar›n nedeni olabilir mi?
Clinical, electrophysiological and immunological remissions after thymectomy in myasthenia gravis
Clinical Neurophysiology, 2002
Approximately 50% of patients treated with thymectomy have a chance for symptom-free life. However, immunological and neurophysiological abnormalities may be detected in patients with clinical remission. Although improvement usually parallels decrease in acetylcholine receptor antibody (AChRAb) levels and jitter values, there is a question what factors influence immunological and electrophysiological remission in a population of myasthenia gravis (MG) patients. We analyzed retrospectively clinical data of 32 MG patients operated for generalized MG, followed-up at our department for 17.2 (4-31) years. They were in clinical remission for 12.8 (2-25) years. All of them had single fiber electromyograhy (SFEMG) of extensor digitorum communis muscle (EDC) muscle and estimation of AChRAb level at the end of follow-up. Their age at onset of MG was 17 years (6-48) and at thymectomy 19 (6.4-58) years. Tensilon test was positive in 30, repetitive nerve stimulation in 29 cases. Clinical remission was reached on average 4.2 years after thymectomy. SFEMG jitter value normalized in 60% of cases. AChRAb were negative only in 34% of patients. Jitter values correlated with AChRAb levels (P=0.006, r=0.5) but were not related to clinical factors. Only time to thymectomy correlated with time from thymectomy to clinical remission (P=0.001, r=0.5). Clinical remission is not always accompanied by normalization of SFEMG and AChRAb. Although normalization of neuromuscular transmission in patients with remission of MG is individual, short duration of MG before thymectomy increases the chance of early remission.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2015
Postoperative myasthenic crisis (POMC) is one of the serious complications after extended thymectomy for patients with myasthenia gravis (MG). This study aims to clarify the risk factors of POMC occurrence. The clinical data of 55 MG patients (25 male, 30 female; median age, 51 years) who underwent extended thymectomy at Kyoto University from 2000 to 2013 were retrospectively reviewed. Surgical outcomes and pre- and perioperative predictive factors of POMC were analysed. The preoperative Myasthenia Gravis Foundation of America stage was I, II, III and IV in 24, 22, 8 and 1 patients, respectively. Ten patients (18.2%) developed POMC; 6 required prolonged intubation over 24 h and 4 required reventilatory support. All patients were weaned after 5.6 (2-26) days of ventilator support, and were discharged. Univariate analysis revealed a correlation with a high preoperative anti-acetylcholine receptor antibody titre (P = 0.009), history of myasthenic crisis (MC) (P = 0.0004) and unstable M...
Outcome of thymectomy in myasthenia gravis patients at Neurological Institute of Thailand
Neurology Asia
Background & Objective: Myasthenia gravis is the most common neuromuscular junction disorders and is caused by autoantibodies against acetylcholine receptors at the postsynaptic muscle endplate. Although thymectomy is current standard treatment but the benefit in long-term outcomes and in non- thymomatous generalized MG patients with negative AChR antibody are still unclear. The objective is to determine the treatment outcomes of thymectomy in non-thymomatous generalized MG patients with or without AChR antibody and identify features related to remission. Methods: Retrospective chart review of the patients diagnosed with non-thymomatous generalized MG from January 1st, 2014 to December 31th, 2018. Patients were classified into two groups: patients with thymectomy (thymectomy group) and patients with no thymectomy (medication group). Results: Seventy-six patients were included. All baseline clinical features, investigations and treatment response were compared. At 6 and 12 months fol...
Clinical outcome of thymectomy in myasthenia gravis patients: A report from Iran
Iranian journal of neurology, 2018
Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is done in these patients and is a mainstay in the treatment of MG; however, the long-term result of surgery is still controversial. This study dealt with the investigation of the results of thymectomy in treatment, recovery and control of the symptoms of these patients. This study was performed through a retrospective method in patients suffering from MG who underwent trans-sternal thymectomy between 2011 and 2016. We conducted thymectomy, excision of mediastinal mass and contents of tissues between the right and left phrenic nerves for all patients. Then, the effect of various variables including age, sex, time interval between onset of disease and surgery, thymus pathology and the dosage of drug on clinical response after surgery was determined using various statistical tests. 47 patients including 26 men and 21 women with the mean age of 33.0 ± 4.6 years...
Risk factors for developing postthymectomy myasthenia gravis in thymoma patients
The Annals of thoracic surgery, 2015
Thymoma patients with no prior history of myasthenia gravis (MG) occasionally have MG after thymectomy. This study aimed to identify risk factors for developing postthymectomy MG. We retrospectively reviewed the characteristics and clinical outcomes of thymoma patients without preoperative MG who underwent a thymectomy at our institute. Of the 229 thymoma patients who underwent surgery from 1991 to 2011, 123 had no history of MG. The serum of all patients was analyzed for acetylcholine receptor antibodies (AchR-Ab), and 33 patients had detectable levels (greater than 0.2 nmol/L). Ten seropositive patients had MG develop postoperatively within 3 to 2,859 days, whereas 90 seronegative patients did not. Univariate analysis showed that a positive result for serum AchR-Ab (p < 0.001), type B1/B2/B3 thymoma histology (p = 0.025), and incomplete resection (p = 0.008) were risk factors for the development of MG. In patients with post-thymectomy MG, the AchR-Ab levels at the onset of MG w...
Review Analysis on Thymectomy vs Conservative Medical Management in Myasthenia Gravis
Cureus, 2020
Myasthenia gravis (MG) is an acquired, rare autoimmune disease that occurs due to autoantibodies blocking neuromuscular transmission. Its pathophysiology involves production of antibodies against the nicotinic acetylcholine receptors. Patients with negative anti-acetylcholine receptors (AChR) antibodies results are recognized as seronegative myasthenia gravis. In this review we tried to compare surgical and medical management of MG with each other to find out which is more effective. Different clinical trials and retrospective cohorts comparing these two parameters statistically were searched and studied. Remission rates in both medical and surgical management were compared. We found out that rates of remission were better in post thymectomy patients than patients on various medical treatment options including corticosteroids, immunosuppressants, intravenous immunoglobulins and acetylcholinesterase inhibitors alone. Hence thymectomy is studied to be the superior treatment option than other conservative medical management options alone.