Treatment of myasthenia gravis: a comparison of the natural course and current therapies.
Ninety-five patients with generalized myasthenia gravis were followed for 10 years to evaluate the long term effects of prednisolone, thymectomy, or both, and they were compared with a group only with anticholinesterase treatment. Only 15.0% of the patients with anticholinesterase alone had showed improvement 10 years after the onset, but more than 60% of those treated with prednisolone, thymectomy, or both showed improvement. Especially thymectomy induced complete remissions at 10 years after surgery in more than 20% of the patients. There was no difference between the histology of the thymi and clinical severity, or anti-acetylcholine receptor (AChR) antibody titer. In patients who showed improvement classified "good" of higher 10 years after thymectomy with or without prednisolone, anti-AChR antibody titers swiftly decreased to 37.8% of the value before surgery, and remained low thereafter. This result suggests that the marked decrease in anti-AChR antibody titers within 1 month after thymectomy is a favorable prognostic sign in myasthenia gravis patients who have undergone thymectomy.
Seto
M
M
First Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Motomura
M
M
Takeo
G
G
Yoshimura
T
T
Tsujihata
M
M
Nagataki
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011239:Prednisolone / Q000627:therapeutic use; D011950:Receptors, Cholinergic / Q000276:immunology; D013934:Thymectomy; D013950:Thymus Gland / Q000473:pathology
D002800:Cholinesterase Inhibitors; D011950:Receptors, Cholinergic; D011239:Prednisolone