Thymectomy and antimuscle antibodies in nonthymomatous myasthenia gravis.
The clinical effect of thymectomy in early- and late-onset myasthenia gravis (MG) and the correlation to MG severity, pharmacological treatment, and antimuscle antibodies were examined in two series of consecutive acetylcholine receptor (AChR) antibody-positive nonthymoma MG patients. The results indicate a benefit of thymectomy in early-onset MG, but no obvious clinical benefit in late-onset MG. The presence of muscle autoantibodies did not influence the outcome of thymectomy in early-onset MG. In late-onset MG, improvement is least likely in patients with titin and/or RyR antibodies. Thymectomy should always be considered shortly after MG onset in early-onset MG patients and might only be considered in late-onset patients who have early-onset-like immunological characteristics.
Romi
Fredrik
F
Department of Neurology, Haukeland University Hospital, N-5021 Bergen, Norway. fredrik.romi@haukeland.no
Gilhus
Nils E
NE
Varhaug
Jan E
JE
Myking
Andreas
A
Skeie
Geir O
GO
Aarli
Johan A
JA
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000906:Antibodies / Q000378:metabolism; D001323:Autoantibodies / Q000097:blood; D015153:Blotting, Western; D064211:Connectin; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009124:Muscle Proteins / Q000276:immunology; D018908:Muscle Weakness / Q000209:etiology / Q000276:immunology; D009157:Myasthenia Gravis / Q000097:blood / Q000150:complications / Q000628:therapy*; D011494:Protein Kinases / Q000276:immunology; D011950:Receptors, Cholinergic / Q000276:immunology; D012074:Remission Induction; D019837:Ryanodine Receptor Calcium Release Channel / Q000276:immunology; D012720:Severity of Illness Index; D013934:Thymectomy; D013945:Thymoma / Q000150:complications / Q000601:surgery / Q000628:therapy; D013950:Thymus Gland / Q000473:pathology / Q000601:surgery; D013953:Thymus Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome
D000906:Antibodies; D001323:Autoantibodies; D064211:Connectin; D009124:Muscle Proteins; D011950:Receptors, Cholinergic; D019837:Ryanodine Receptor Calcium Release Channel; C577285:TTN protein, human; D011494:Protein Kinases