Two-year outcome of thymectomy in non-thymomatous late-onset myasthenia gravis.

Abstract

Thymectomy is an effective treatment for myasthenia gravis (MG). However, there is limited data on its effectiveness in non-thymomatous late-onset MG (LOMG). The aim of this study was to analyze the effects of thymectomy in LOMG. We retrospectively reviewed the 2-year post-thymectomy prognosis in 39 consecutive patients with non-thymomatous, anti-acetylcholine receptor antibody positive, and generalized LOMG (age at onset ≥ 50 years). The MG foundation of America (MGFA) classification, MGFA post-intervention status, dosage of prednisolone and pyridostigmine, and anti-acetylcholine receptor antibody titers were evaluated. Among the 39 LOMG patients, thymic hyperplasia was seen in 5 (12.8%). MGFA classification and prednisolone dosage before thymectomy were similar between the LOMG with thymic hyperplasia group (n = 5) and the LOMG with involuted thymus group (n = 34). Two years after thymectomy, the LOMG patients with thymic hyperplasia showed higher proportion of remission (60 vs. 26%) and received lower prednisolone dosage compared to patients with involuted thymus (0.8 vs. 4.0 mg/day). Notably, the proportion of patients with minimal manifestation or better status with receiving ≤ 5 mg/day prednisolone was much higher in the thymic hyperplasia group than in the involuted thymus group (100 vs. 62%). In conclusion, thymectomy could have beneficial effects in generalized LOMG, particularly in patients with thymic hyperplasia.

• Authors: Akiyuki Uzawa, Naoki Kawaguchi, Tetsuya Kanai, Keiichi Himuro, Fumiko Oda, Shigetoshi Yoshida, Ichiro Yoshino, Satoshi Kuwabara
• Journal: Journal of neurology (J Neurol) Vol. 262 Issue 4 Pg. 1019-23 ( 2015) ISSN: 1432-1459 [Electronic] Germany
• PMID: 25683765 (Publication Type: Journal Article)

Chemical References

• Autoantibodies
• Cholinesterase Inhibitors
• Glucocorticoids
• Receptors, Cholinergic
• Prednisolone
• Pyridostigmine Bromide

Topics

• Age of Onset
• Aged
• Autoantibodies (blood)
• Cholinesterase Inhibitors (therapeutic use)
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Myasthenia Gravis (blood, drug therapy, surgery)
• Prednisolone (therapeutic use)
• Pyridostigmine Bromide (therapeutic use)
• Receptors, Cholinergic (immunology)
• Thymectomy (methods)
• Thymus Gland (abnormalities, drug effects, surgery)
• Tomography Scanners, X-Ray Computed
• Treatment Outcome