Experience with programmed steroid treatment with thymectomy in nonthymomatous myasthenia gravis.
BACKGROUND
The benefit of thymectomy in myasthenia gravis management is recognized but the perioperative course can fluctuate. The goal of this study was to assess the feasibility and clinical benefit of dose-escalated steroid therapy with thymectomy for nonthymomatous myasthenia gravis.


METHODS
We reviewed the records of 69 myasthenia gravis patients who were followed up after undergoing transsternal thymectomy with extended anterior mediastinal dissection in our hospital between 1976-2000. Forty-eight patients in the programmed treatment group who had dose-escalated and de-escalated steroid therapy during the perioperative period comprised 17 patients with ocular myasthenia gravis and 31 patients with generalized myasthenia gravis. Clinical benefits and clinical remission, which was diagnosed when the patients were symptom-free without medications for at least 1 year, were compared with those of 21 patients in the occasional treatment group who received medications occasionally over the perioperative period.


RESULTS
Postoperative respiratory failure and myasthenic crisis did not occur in the programmed treatment group but did occur in 6 patients in the occasional treatment group. Remission rates in the programmed treatment group (mean follow-up, 6.4 years) were 30% at 3 years, 38% at 5 years, and 46% at 10 years; rates in the occasional treatment group (mean follow-up, 9.6 years) were 25% at 3 years, 25% at 5 years, and 45% at 10 years.


CONCLUSIONS
Programmed steroid therapy in patients with nonthymomatous myasthenia gravis is feasible and it provides clinical benefit when fluctuating symptoms occur during the perioperative period.
Endo
Shunsuke
S
Division of General Thoracic Surgery, Department of Surgery, Jichi Medical School, Kawachi-gun, Tochigi, tcvshun@jichi.ac.jjpJapan.
Yamaguchi
Tsutomu
T
Saito
Noriko
N
Otani
Shinichi
S
Hasegawa
Tsuyoshi
T
Sato
Yukio
Y
Sohara
Yasunori
Y
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000601:surgery; D015999:Multivariate Analysis; D009157:Myasthenia Gravis / Q000601:surgery*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012074:Remission Induction; D012189:Retrospective Studies; D013934:Thymectomy / Q000379:methods
D005938:Glucocorticoids; D011239:Prednisolone