Comparison of Conservative Treatment and Thymectomy on Myasthenia Gravis Outcome

Introduction. Myasthenia gravis is an autoimmune disease caused by antibodies leading to the destruction of nicotinic acetylcholine receptors on the neuromuscular junction. It is characterized by muscle weakness that gets aggravated with physical activity and improves at rest. Myasthenia Gravis Foundation of America made the clinical classification of Myasthenia gravis which is still in use today. ?Tensilon test? is still the gold standard for the diagnosis of Myasthenia gravis. In addition to this test repeated muscular stimulation can be used as well as the analysis of specific autoantibodies. Treatment of Myasthenia Gravis. In conservative treatment of Mysthenia gravis anticholinesterases, immunosuppressants and plasmapheresis can be used. If conservative treatment does not lead to the desired remission, surgical treatment is indicated. The most accepted indication for thymectomy is the presence of thymoma with generalized form of Myasthenia gravis in adults. How to Distinguish Myasthenic From Cholinergic Crisis. The following is important to make a difference between these two crises: knowledge of the events that preceded the crisis, the size of pupils as well as the presence of muscarinic signs and tensilon test. Specific Features of Anesthesia in Patients with Myasthenia Gravis. Mechanism of the disease development is the reason for the increased sensitivity or resistance of these patients to certain types of drugs used in anesthesia. Protocol of Perioperative Anesthesia in Patients with Myasthenia Gravis. Based on 35 years of experience in the surgical treatment of patients with Myasthenia gravis anesthesiologists at the Department of Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, made the protocol of anesthesia and perioperative treatment for these patients. Conclusion. Anesthesiologists may have to deal with a patient with myasthenia gravis in different types of surgical interventions. The protocol for anesthesia and perioperative management of these patients herewith presented may greatly help them in their clinical practice.

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Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement

Surgery ◽

10.1016/j.surg.2008.11.009 ◽

2009 ◽

Vol 145 (4) ◽

pp. 392-398 ◽

Cited By ~ 25

Author(s):

Kai Bachmann ◽

Doreen Burkhardt ◽

Inken Schreiter ◽

Jussuf Kaifi ◽

Paulus Schurr ◽

...

Keyword(s):

Conservative Treatment ◽

Myasthenia Gravis ◽

Clinical Improvement

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Effects of thymectomy on late-onset non-thymomatous myasthenia gravis: systematic review and meta-analysis

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01860-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jinwei Zhang ◽

Yuan Chen ◽

Hui Zhang ◽

Zhaoyu Yang ◽

Peng Zhang

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Myasthenia Gravis ◽

Early Onset ◽

Odds Ratio ◽

Late Onset ◽

Meta Analysis ◽

Therapeutic Strategies ◽

Cochrane Library ◽

Study Objective

Abstract Background The effects of thymectomy on late-onset non-thymomatous myasthenia gravis (NTMG) remain controversial. The objective of this study was to conduct a systematic review in order to answer two questions pertinent to late-onset NTMG: (1) do patients with late-onset NTMG experience the same effects from thymectomy as their early-onset counterparts? (2) Compared with conservative treatment, does thymectomy have any benefits for late-onset NTMG patients? Methods We searched the PubMed, EMBASE, and Cochrane Library databases for studies published from January 1, 1950 to March 10, 2021. Outcomes were measured via clinical stable remission/pharmacological remission (CSR/PR) and improvement rates. We used Stata software to analyze the data. Results We ultimately included a total of 12 observational articles representing the best evidence answering the questions of our study objective. Of these, nine studies, which included 896 patients overall (766 early-onset and 230 late-onset), compared postoperative outcomes between early- and late-onset NTMG. The remaining three articles, which included 216 patients (75 in the thymectomy group and 141 in the conservative-treatment group), compared thymectomy with conservative treatment for late-onset NTMG. The early- versus late-onset NTMG studies demonstrated that patients in the former category were 1.95× likelier than their late-onset counterparts to achieve clinical remission (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.39–2.73; I2 = 0%). No difference was seen in improvement or remission + improvement rates between these two groups. When comparing thymectomy with conservative treatments in late-onset NTMG patients, neither did we observe any difference in CSR/PR. Conclusion We found that late-onset NTMG patients had a lower chance of achieving CSR after thymectomy than early-onset patients. Thymectomy in late-onset NTMG also yielded no benefit to CSR or PR compared with conservative treatments. In late-onset NTMG patients, thymectomy should therefore be performed with caution, and the appropriate cutoff between early- and late-onset MG should be further explored in order to tailor and execute the proper therapeutic strategies.

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BENEFITS OF THYMECTOMY IN MYASTHENIA GRAVIS

10.36106/paripex/3102463 ◽

2020 ◽

pp. 1-3

Author(s):

Manoj M Josh ◽

Hrishikesh Parashi ◽

Vignesh Ravikumar

Keyword(s):

Conservative Treatment ◽

Minimally Invasive ◽

Myasthenia Gravis ◽

Randomized Trials ◽

Disease Classification ◽

Mild Disease ◽

Randomized Controlled Studies ◽

And Gender ◽

Invasive Techniques ◽

Better Than

In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia,there was no relationship between age and gender in remission with thymectomy. In MG treatment,randomized trials that compare conservative treatment with thymectomy have started,recently.As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication.There are four major methods for the surgical approach:transcervical,minimally invasive,transsternal,and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods.There are not any randomized, controlled studies which are comparing surgical techniques.However,when comparing non-randomized trials,it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.

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