Safia Bano, Muhammad Athar Javed, Waqas Arshad.
Outcome in patients with myasthenia gravis Managed with or without Thymectomy.
Pak J Neurological Sci Jan ;14(4):13-7.

BACKGROUND: Myasthenia gravis is a chronic acquired autoimmune disorder in which autoantibodies are produced against acetylcholine receptors present on neuromuscular junction. It results in neuromuscular transmission blockage hence muscle weakness occurs. Thymus gland is considered as having crucial role in development of these antibodies. Screening patients for thymoma and removal of the thymus gland with surgery has an important aspect in management of disease. OBJECTIVE: To compare the clinical outcome of patients with myasthenia gravis treated with or without thymectomy. MATERIAL AND METHODS: Study design: Retrospective observational comparative study. SETTING: Department of Neurology, Mayo hospital, Lahore. Duration: patients with myasthenia gravis from 2014 to 2017. Procedure: 40 Patients with myasthenia gravis Osserman stage from 1 to 4 treated from 2014 to 2017, irrespective of age and gender were included. Diagnosis of myasthenia Gravis was based on positive EMG study, acetylcholine receptor antibodies and Pyridostigmine test (as Edrophonium was not available). Records of 20 patients that underwent thymectomy and 20 patients which were managed conservatively were obtained. Outcome in patients having thymectomy was assessed on the basis of MGFA Post intervention status after 1year. RESULTS: study sample (40 patients) includes 15 males and 25 females. The mean age of patients was 33 years (range 14 to 63, SD 11.2). In thymectomy group, 7 males and 13 females (age range 16 to 53years, means age 32, SD 10) that underwent thymectomy. With thymectomy, 14 patients improved, 6 remained unchanged while no patients showed worsening or exacerbation of their symptoms. There were 8 males and 12 females of age 14 to 63 years that were managed without thymectomy. Of them, 2 patients improved, 6 remained unchanged, and 12 had worsened symptoms while no patients showed exacerbated symptoms. The difference among the two groups was statistically significant (p<0.05). Conclusion: After thymectomy there was a substantial dose reduction in antimyasthenic treatment with minimum or no exacerbation as compared to patients without thymectomy. So all patients of myasthenia gravis should be offered thymectomy as a part of treatment. This conclusion is in line with guidelines for the management of myasthenia gravis.

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