title: Unsatisfactory outcomes in myasthenia gravis: influence by care providers.
abstract: Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes.
authors.affiliation: Nerve-Muscle Unit, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011, Lausanne, Switzerland. murielle.dunand@chuv.ch
authors.forename: Murielle
authors.initials: M
authors.lastname: Dunand
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Botez
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Borruat
authors.forename: Pascale
authors.initials: P
authors.lastname: Roux-Lombard
authors.forename: François
authors.initials: F
authors.lastname: Spertini
authors.forename: Thierry
authors.initials: T
authors.lastname: Kuntzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D009462:Neurology / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000627:therapeutic use; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D013934:Thymectomy / Q000706:statistics & numerical data; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011729:Pyridostigmine Bromide; D001379:Azathioprine; D011241:Prednisone